Sample records for analgesia multimodal preventiva

  1. Multimodal Analgesia in the Hip Fracture Patient.

    Fabi, David W


    Hip fracture is one of the most common injuries among the elderly and, because the population is aging, it is expected to remain a major clinical challenge and public health problem for the foreseeable future. The clinical importance of early mobilization and prompt participation in physical therapy after hip fracture surgery is now widely recognized. Because postoperative pain can impair mobility and delay physical therapy, much attention is now being paid to finding more effective ways of controlling pain after hip fracture. Oversedation with opioid drugs inhibits communication between the patient and the health care team, can delay ambulation and rehabilitation therapy, and may increase the probability of the patient requiring a skilled nursing facility, which adds further cost to the overall health care system. Multiple pain pathways contribute to the perception of postoperative pain, and although opioids are highly effective in blocking nociceptive pain through inhibition of the mu receptors, they do not block other pain pathways. Multimodal analgesia involves the use of several anesthetic and analgesic modalities that are strategically combined to block pain perception at different sites in the peripheral and central nervous systems. This balanced, multifaceted approach provides more effective control of postoperative pain than opioid drugs alone, allows lower doses of opioids to be used as part of the multimodal regimen (thereby reducing the risk of opioid-related adverse events and complications), and may facilitate more rapid recovery and improve certain outcome measures related to recovery time. One prospective randomized study evaluating the clinical value of multimodal pain management in elderly patients undergoing bipolar hip hemiarthroplasty found that a multimodal regimen, including preemptive pain medication and intraoperative periarticular injections, reduced pain on postoperative days 1 and 4, and reduced overall opioid use. This article describes

  2. Effects of Multimodal Analgesia on the Success of Mouse Embryo Transfer Surgery

    Parker, John M.; Austin, Jamie; Wilkerson, James; Carbone, Larry


    Multimodal analgesia is promoted as the best practice pain management for invasive animal research procedures. Universal acceptance and incorporation of multimodal analgesia requires assessing potential effects on study outcome. The focus of this study was to assess effects on embryo survival after multimodal analgesia comprising an opioid and nonsteroidal antiinflammatory drug (NSAID) compared with opioid-only analgesia during embryo transfer procedures in transgenic mouse production. Mice w...

  3. Nefopam analgesia and its role in multimodal analgesia: A review of preclinical and clinical studies.

    Girard, Philippe; Chauvin, Marcel; Verleye, Marc


    Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug used to prevent postoperative pain, primarily in the context of multimodal analgesia. This paper reviews preclinical and clinical studies in which nefopam has been combined with opioids, non-steroidal anti-inflammatory compounds, and paracetamol. This report focuses on the literature during the last decade and discusses the translational efforts between animal and clinical studies in the context of multimodal or balanced analgesia. In preclinical rodent models of acute and inflammatory pain, nefopam combinations including opioids revealed a synergistic interaction or enhanced morphine analgesia in six out of seven studies. Nefopam combinations including non-steroidal anti-inflammatory drugs (NSAIDs) (aspirin, ketoprofen or nimesulide) or paracetamol likewise showed enhanced analgesic effects for the associated compound in all instances. Clinical studies have been performed in various types of surgeries involving different pain intensities. Nefopam combinations including opioids resulted in a reduction in morphine consumption in 8 out of 10 studies of severe or moderate pain. Nefopam combinations including NSAIDs (ketoprofen or tenoxicam) or paracetamol also demonstrated a synergic interaction or an enhancement of the analgesic effect of the associated compound. In conclusion, this review of nefopam combinations including various analgesic drugs (opioids, NSAIDs and paracetamol) reveals that enhanced analgesia was demonstrated in most preclinical and clinical studies, suggesting a role for nefopam in multimodal analgesia based on its distinct characteristics as an analgesic. Further clinical studies are needed to evaluate the analgesic effects of nefopam combinations including NSAIDs or paracetamol. PMID:26475417

  4. Multimodal analgesia for perioperative pain in three cats.

    Steagall, Paulo V M; Monteiro-Steagall, Beatriz P


    Adequate pain relief is usually achieved with the simultaneous use of two or more different classes of analgesics, often called multimodal analgesia. The purpose of this article is to highlight the use of perioperative multimodal analgesia and the need to individualize the treatment plan based on the presenting condition, and to adjust it based on the response to analgesia for a given patient. This case series presents the alleviation of acute pain in three cats undergoing different major surgical procedures. These cases involved the administration of different classes of analgesic drugs, including opioids, non-steroidal anti-inflammatory drugs, tramadol, ketamine, gabapentin and local anesthetics. The rationale for the administration of analgesic drugs is discussed herein. Each case presented a particular challenge owing to the different cause, severity, duration and location of pain. Pain management is a challenging, but essential, component of feline practice: multimodal analgesia may minimize stress while controlling acute perioperative pain. Individual response to therapy is a key component of pain relief in cats. PMID:23382595

  5. Preventive local analgesia in orthopedic and Traumatology surgery. Analgesia local preventiva en la cirugía traumatológica y ortopédica.

    Carlos M. Hernández


    posoperatorio es entonces una prioridad de la medicina moderna. Objetivo: Caracterizar los resultados obtenidos con la aplicación de analgesia preventiva infiltrando la herida operatoria sin restringir el uso de otros analgésicos si fuera necesario. Métodos: Estudio prospectivo descriptivo en una serie de 30 pacientes atendidos por del Servicio de Ortopedia del Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos en el período de septiembre de 2004 a marzo de 2005. Se les aplicó una infiltración anestésica en el área quirúrgica una vez finalizada la intervención, con bupivacaína al 0,125 % en un volumen de 20 ml y 2 gotas de epinefrina sin restringir el uso de otros analgésicos. Resultados: Comprobamos que 13 enfermos no presentaron dolor dentro de las primeras 24-48 horas posoperatorias, seguido por otro grupo formado por 9 en que existió alivio entre las 12 y 23 horas. Conclusiones: En la serie de pacientes estudiados se comprobaron los beneficios de la infiltración anestésica en el área quirúrgica con fines analgésicos, al proporcionar ausencia de dolor en un período mayor de 24 horas en gran número de pacientes. La bupivacaína presentó buenos resultados por proporcionar una analgesia posoperatoria y la aplicación temprana de la rehabilitación en buen número de casos.

  6. Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia

    Lim, Se Hun; Jang, Eun Ho; KIM, Myoung-Hun; Cho, Kwangrae; Lee, Jeong Han; Lee, Kun Moo; Cheong, Soon Ho; Kim, Young-Jae; Shin, Chee-Mahn


    Background Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. Methods One ...

  7. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: A randomized trial study1

    Pinheiro, Valdecy Ferreira de Oliveira; da Costa, José Madson Vidal; Cascudo, Marcelo Matos; Pinheiro, Ênio de Oliveira; Fernandes, Maria Angela Ferreira; de Araujo, Ivonete Batista


    Objective: to assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. Methods: sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. Results: the groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47). The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. Conclusion: the present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious. PMID:26625989

  8. Effects of multimodal analgesia on the success of mouse embryo transfer surgery.

    Parker, John M; Austin, Jamie; Wilkerson, James; Carbone, Larry


    Multimodal analgesia is promoted as the best practice pain management for invasive animal research procedures. Universal acceptance and incorporation of multimodal analgesia requires assessing potential effects on study outcome. The focus of this study was to assess effects on embryo survival after multimodal analgesia comprising an opioid and nonsteroidal antiinflammatory drug (NSAID) compared with opioid-only analgesia during embryo transfer procedures in transgenic mouse production. Mice were assigned to receive either carprofen (5 mg/kg) with buprenorphine (0.1 mg/kg; CB) or vehicle with buprenorphine (0.1 mg/kg; VB) in a prospective, double-blinded placebo controlled clinical trial. Data were analyzed in surgical sets of 1 to 3 female mice receiving embryos chimeric for a shared targeted embryonic stem-cell clone and host blastocyst cells. A total of 99 surgical sets were analyzed, comprising 199 Crl:CD1 female mice and their 996 offspring. Neither yield (pups weaned per embryo implanted in the surgical set) nor birth rate (average number of pups weaned per dam in the set) differed significantly between the CB and VB conditions. Multimodal opioid-NSAID analgesia appears to have no significant positive or negative effect on the success of producing novel lines of transgenic mice by blastocyst transfer. PMID:21838973

  9. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    Werner, M U; Gaarn-Larsen, L; Basse, L;


    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...

  10. Analgesia preemptiva nas cirurgias da coluna lombossacra: estudo prospectivo e randomizado Analgesia preventiva en las cirugías de la columna lumbosacra: estudio prospectivo y aleatorio Preemptive analgesia in lumbosacral spine surgeries: prospective randomized study

    Augustin Malzac


    Full Text Available OBJETIVO: Analisar a eficácia da analgesia preemptiva pelo método da administração de analgésicos antes e após o início do estímulo doloroso operatório, comparando-as. A melhora do quadro doloroso pós-operatório nas cirurgias da coluna vertebral no segmento lombossacro, por via posterior, não tem sido completamente investigada. MÉTODOS: Sessenta e dois pacientes submetidos à microdiscectomia ou microdescompressão, em um único nível, na coluna lombossacra, foram divididos em três grupos, 20 pacientes no primeiro (A não receberam qualquer substância analgésica (controle. Vinte e dois no segundo (B, os quais foram submetidos à injeção epidural, 20 minutos antes da incisão cirúrgica, contendo 10 mL de marcaína e morfina. No terceiro e no último grupo (C com vinte pacientes, foi injetado, com auxílio de um cateter, no espaço epidural, as mesmas drogas do grupo B, através da incisão antes do fechamento da ferida operatória. Os pacientes foram examinados durante as primeiras 24 horas com auxílio da escala verbal de dor. RESULTADOS: Os três grupos foram comparados quanto à idade, sexo, nível e tempo cirúrgico. Os dados não obedeceram a uma distribuição Gaussiana, o teste não paramétrico de Mann-Whitney foi adotado para análise estatística. Desta maneira, os valores da escala verbal de dor, em todos os intervalos de tempo, foram significativamente baixos (pOBJETIVO: analizar la eficacia y comparar la analgesia preventiva por el método de la administración de analgésicos antes y después del inicio del estímulo doloroso operatorio. La mejoría del cuadro doloroso postoperatorio en las cirugías de la columna vertebral en el segmento lumbosacro, por vía posterior, no ha sido completamente investigada. MÉTODOS: sesenta y dos pacientes sometidos a la microdisección o microdescompresión, en un único nivel, en la columna lumbosacra fueron divididos en tres grupos. Veinte pacientes en el primer grupo (A no

  11. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post–cesarean section pain management

    Adeniji AO


    Full Text Available Adetunji Oladeni Adeniji,1 Oluseyi Olaboyede A Atanda21Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; 2Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, NigeriaBackground: Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post–cesarean section pain management.Objective: To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam approach, in the management of post–cesarean section pain.Materials and methods: This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg or tramadol (100 mg as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post–cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.Results: A total of 120 patients were equally and randomly allocated to four study groups – two that received unimodal analgesia (the pentazocine group and the tramadol group and two that received multimodal analgesia (the pentazocine

  12. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

    Rafiq, Sulman; Steinbrüchel, Daniel Andreas; Wanscher, Michael Jaeger;


    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective...

  13. New progress of orthopaedic postoperative multimodal analgesia%骨科术后多模式镇痛新进展



    针对手术后疼痛,单一药物和方法无法达到最佳效果,多模式镇痛是近年来提出的一种新的镇痛观念.阐述了术后疼痛的机制、影响术后疼痛的一些因素,并说明术后镇痛在术后治疗中所起的重要作用;介绍了骨科手术后疼痛所采取的多模式镇痛的各种常用镇痛药物和多种镇痛方法,并对其研究的前景作一展望.%A single drug or a method may not achieve the best result for the management post-operative pain, so multimodal analgesia is proposed as a new analgesic concept in recent years. This article describes the mechanism of postoperative pain, some of the factors affecting postoperative pain and the importance of the treatment of postoperative pain after surgery. It also introduces a variety of analgesic drugs and methods commonly used as multimodal analgesia in postoperative pain treatment in orthopaedic. Foreground of the research is prospected as well.


    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne;

      PURPOSE: The purpose of this project was to study the length of the hospital stay (LOS) in relation to a new multimodal pain strategy for patients undergoing elective hip and knee arthroplasty. Usual discharge criteria were used: independence in ambulation and transfers, independence in toileting...... and dressing, and pain medication with only oral analgesics. RELEVANCE: Current efforts focus to shorten the LOS and improve pain management. However, a decreased LOS has to ensure restoration of functional ability to the same level achieved with traditional LOS. Accordingly a description of the...... medication. Patients started mobilisation on the day of the operation with further physiotherapy the following days, including transfer and ambulation training, and specific joint and muscle exercises. In connection with all activities, pain scores were assessed, using a Visual Analog Scale (VAS). All...

  15. Literature review of the usefulness of the ilioinguinal and iliohypogastric blockade as part of multimodal management of postoperative analgesia

    An specialized literature review was realized for the practice of anesthesiology, revealing the usefulness of blockings of ilioinguinal and iliohypogastric nerves to control pain or postoperative analgesia. Pain and acute postoperative pain are defined. Also, the different techniques or pharmacological options for treating and controlling postoperative pain are determined. For example, systemic opioid and non-opioid analgesics, regional analgesic techniques (neuraxial and peripheral). The use of ultrasound is described as technical support to regional anesthesia and nerve block guided by images

  16. Multimodality

    Buhl, Mie

    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal’ communication, which should not be confused with the term ‘multimedia’. While multimedia...... learning situations. The choices they make involve E-learning resources like videos, social platforms and mobile devices, not just as digital artefacts we interact with, but the entire practice of using digital media. In a life-long learning perspective, multimodality is potentially very useful for...... represent the use of various media for communication, multimodality refers to the different symbol systems we employ in communication practices. As new educational practices emerge from the application of ICT, all teachers address multimodality when they plan, practice and reflect on their teaching and...

  17. Multimodality

    Buhl, Mie


    In this paper, I address an ongoing discussion in Danish E-learning research about how to take advantage of the fact that digital media facilitate other communication forms than text, so-called ‘multimodal' communication, which should not be confused with the term ‘multimedia'. While multimedia r...

  18. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk; Harazuk, Jørgen; Pedersen, Niels A; Søballe, Kjeld


    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion on...

  19. Analgesia in PACU: indications, monitoring, complications.

    Savoia, Gennaro; Gravino, Elvira; Loreto, Maria; Erman, Alfredo


    The correct treatment of postoperative pain, in the early period immediately following surgery, is founded on the following four principles: 1-correct diagnosis of the source and magnitude of nociception; 2-understanding of the relationship of ongoing nociception and other components of pain including anxiety, ethnocultural components, meaning, prior experience; 3-treatment by establishment and maintenance of drug level at active sites to achieve and maintain analgesia and anxiolysis as appropriate; 4-continued re-evaluation of the therapy and refinement of the approach. The PACU standard of cure requires a strict accordance between intra and postoperative analgesia. It requires "proactive preoperative plan" that includes: preoperative patient evaluation; discussion with a single patient on different treatment options; patient and family education; pre-emptive measures as indicated; intra-operative multimodal analgesia; a correct triage of analgesia, just after initial evaluation of vital parameters in PACU; re-evaluation of analgesia plan, if analgesia is inadequate; a new titration, intravenous or epidural way, in order to achieve a stable VAS < 3; plan a new analgesia scheme or confirm a preoperative plan; control of adverse events, related to analgesia plan (gastric bleeding and/or bleeding of the surgical wound site, NSAIDs-induced renal damage, respiratory depression, delayed canalisation, nausea, vomiting, excessive sedation, difficulty in bladder emptying, itchiness); a transmission of analgesia plan to ward nurses; a control quality for verify at prefixed times patients satisfaction level, analgesia performed, adverse effects percent, analgesia related, plan variations percent. PMID:16305454

  20. Analgesia multimodal para el postoperatorio en la enfermedad renal crónica: fentanilo transcutáneo, fentanilo oral transmucosa y metamizol

    P. Mesa Suárez


    Full Text Available La enfermedad renal crónica (ERC es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM y la hipertensión arterial (HTA. Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para brindarles una analgesia postoperatoria de gran calidad. Presentamos el esquema de analgesia postoperatoria de un paciente en fallo renal severo sometido a artroplastia de cadera: metamizol (6 gramos/24 horas en perfusión durante 48 horas, fentanilo transcutáneo TTS 25 microgramos/hora durante 48 horas y fentanilo oral transmucosa 200 microgramos en caso de exacerbación del dolor. Este tratamiento analgésico permitió el control satisfactorio del dolor sin que se presentaran vómitos, prurito ni estreñimiento; la calidad del sueño y el descanso nocturno fueron buenos.

  1. Preventive analgesia

    Dahl, Jørgen B; Kehlet, Henrik


    This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... findings: The nature of central sensitization during acute and chronic postsurgical pain share common features, and there may be interactions between acute and persistent postoperative pain. The term ‘pre-emptive analgesia’ should be abandoned and replaced by the term ‘preventive analgesia’. Recent studies...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive...

  2. 不同方式超前镇痛对儿童腹腔镜术后多模式镇痛效果的影响%Effect of multimodal analgesia by different ways of preemptive analgesia after laparoscopic surgery in children

    黄俊伟; 曾彩红; 伍淑韫; 梁秀兰; 关柏锐; 黄丹辉


    目的 观察不同方式超前镇痛对儿童腹腔镜术后多模式镇痛安全性及效果的影响.方法 选择在全身麻醉下接受择期腹腔镜手术的患儿90例,年龄5~ 14岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级.采用完全随机双盲法均分为对乙酰氨基酚栓塞肛组(A组)、布托啡诺喷鼻组(B组)和空白对照组(C组).A组患儿全身麻醉后予对乙酰氨基酚栓40 mg/kg塞肛;B组患儿予布托啡诺20μg/kg喷鼻;C组于手术开始前10 min缓慢静脉注射生理盐水2 ml.监测三组患儿术后的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、拔管时间和在PACU停留时间.记录患儿的VAS评分、Ramsay镇静评分及不良反应.结果 A组和B组苏醒期躁动评分显著低于C组(P<0.01).B组镇静评分显著高于A组和C组(P<0.01),A组也高于C组(P<0.05).术后1、4hA组、B组VAS评分显著低于C组(P<0.01),术后8 h VAS评分低于C组(P<0.05);术后1、4、8hB组VAS评分低于A组(P<0.05).C组术后首次按压镇痛泵的时间早于A组和B组(P<0.01),且按压总次数明显多于A组和B组(P< 0.01).结论 对乙酰氨基酚栓塞肛和布托啡诺喷鼻均可为儿童腹腔镜手术提供同样安全、有效的超前镇痛效果,但前者不良反应更少,较适合在基层中推广使用.%Objective To observe the abirritation effect and safety of multimodal analgesia by different ways of preemptive analgesia after laparoscopic surgery in children.Methods 90 patients (5-14 years old,ASA Ⅰ ~ Ⅱ) scheduled for laparoscopic surgery were selected.With a completely randomized and double blind method,they were divided into three groups with 30 patients in each group.Group A received acetaminophen suppository 40 mg/kg by rectal administration after general anesthesia.Group B received transnasal butorphanol 20 μ g/kg after general anesthesia.Group C received an injection of 2 ml saline before the operation.We observed the HR and BP,RR and SPO2,the

  3. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section: a randomised controlled trial.

    Bonnal, A; Dehon, A; Nagot, N; Macioce, V; Nogue, E; Morau, E


    We assessed the effectiveness of early patient-controlled oral analgesia compared with parenteral analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine analgesia. The woman having patient-controlled oral analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral analgesia minus parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral analgesia. More women used morphine in the patient-controlled oral analgesia group (22 (58%)) than in the parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral analgesia. Pruritus was more frequent in the patient-controlled oral analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral analgesia is non-inferior to standard parenteral analgesia for pain management, and can be one of the steps of an enhanced recovery process. PMID:26931110

  4. Analgesia Preventiva, ao Teste do Formol, por Terapia Laser em Ratinhos

    Daniel Pozza; Marília Gerhardt de Oliveira; João Macedo Sobrinho; Nelson Ribeiro Neto


    The present research assessed the analgesic effect of the laser therapy in healthy tissues of 10 mice dividedinto two groups: L: red laser irradiation (665 nm, 30 mW, 10 J/cm2, 334 s). C: control laser irradiation (334 s).After laser therapy formalin solution was injected on the same paw, the animal was placed in a transparentbox and observers recorded the paw rose time during 30 minutes. The results showed statistical differenceand red laser presented better results in all times.

  5. Postoperative analgesia in elderly patients.

    Falzone, Elisabeth; Hoffmann, Clément; Keita, Hawa


    Elderly people represent the fastest-growing segment of our society and undergo surgery more frequently than other age groups. Effective postoperative analgesia is essential in these patients because inadequate pain control after surgery is associated with adverse outcomes in elderly patients. However, management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Physiological changes related to aging need to be carefully considered because aging is individualized and progressive. Assessment of pain management needs to include chronological age, biological age with regard to renal, liver and cardiac functions, and the individual profile of pathology and prescribed medications. In addition, ways in which pain should be assessed, particularly in patients with cognitive impairment, must be considered. Cognitively intact older patients can use most commonly used unidimensional pain scales such as the visual analogue scale (VAS), verbal rating scale (VRS), numeric rating scale (NRS) and facial pain scale (FPS). VRS and NRS are the most appropriate pain scales for the elderly. In older patients with mild to moderate cognitive impairment, the VRS is a better tool. For severe cognitively impaired older patients, behavioural scales validated in the postoperative context, such as Doloplus-2 or Algoplus, are appropriate. For postoperative pain treatment, most drugs (e.g. paracetamol, nonsteroidal anti-inflammatory drugs, nefopam, tramadol, codeine, morphine, local anaesthetics), techniques (e.g. intravenous morphine titration, subcutaneous morphine, intravenous or epidural patient-controlled analgesia, intrathecal morphine, peripheral nerve block) and strategies (e.g. anticipated intraoperative analgesia or multimodal analgesia) used for acute pain management can be used in older patients. However, in view of pharmacokinetic

  6. Historia de la conservación preventiva*. Parte I

    García Fernández, Isabel


    El nacimiento de la conservación preventiva no está muy claro, aunque se puede decir que se encuentra íntimamente ligado a la producción de bienes patrimoniales y el deseo del ser humano de que estos perduren. No obstante, va a ser en el siglo XIX cuando se asienten las bases de la conservación y restauración, y en el siglo XX, cuando se desarrollen los conceptos científicos y de aplicación en el ámbito de los museos. En esta primera parte tratamos la historia de la conservación preventiva de...

  7. Preemptive analgesia II: recent advances and current trends.

    Kelly, D J


    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

  8. Preemptive analgesia I: physiological pathways and pharmacological modalities.

    Kelly, D J


    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

  9. Stellate ganglion blockade for analgesia following upper limb surgery.

    McDonnell, J G


    We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

  10. Fomentar la cultura preventiva entre trabajadores y empresarios

    José Manuel González Tizón


    Full Text Available Desde hace más de una década, la entidad trabaja activamente en la puesta en marcha de acciones preventivas que mejoren las condiciones de seguridad y salud de los trabajadores y empresarios de la zona.

  11. A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

    Himanshu A. Shah


    Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated. [Int J Basic Clin Pharmacol 2013; 2(6.000: 723-727

  12. Role of propacetamol in multimodal analgesia after lumbar spine surgery%丙帕他莫在腰椎术后多模式镇痛中的应用

    陈志峰; 姜虹; 李嫒嫒


    Objective To assess the analgesic effects of propacetamol with fentanyl after lumbar spine surgery. Methods Sixty patients undergoing lumbar spine surgery were randomly divided into two groups, with 30 patients in each group. Patients in group I were treated with 2 g propacetamol IS min before the end of operation, and were managed with self-controlled analgesia ( PCA) pump with fentanyl after operation. Patients in group II were just given PCA pump with fentanyl after operation. PCA pumps were composed of fentanyl with 0.4 u,g ? Kg"1 ? H"', and were used for 48 h. The time of extubation after operation and the analgesia scores, sedation scores, respiration, circulation, vomiting at different time points within 48 h after operation in two groups were recorded. Results There was no significant difference in the time of extubation, and sedation scores, respiration, mean arterial pressure, heart rates and vomiting at different time points after operation between two groups (F>0.05). The analgesia scores in group I were superior to those in group II at the time points of 30 min, 1 h, 2 h, 4 h, 6 h and 12 h after operation (P 0. 05). Conclusion The analgesic effect of propacetamol with fentanyl after surgery is safe and effective.%目的 观察丙帕他莫复合芬太尼对腰椎术后镇痛的应用效果.方法 60例接受腰椎手术患者随机分成2组,每组30例.Ⅰ组手术结束前15 min给予丙帕他莫2 g,术后予芬太尼患者自控镇痛(PCA)泵静脉镇痛,Ⅱ组术后给予芬太尼PCA泵静脉镇痛.两组泵中芬太尼都按0.4 μ·h-1配置,使用48 h.观察两组患者术后拔除气管导管时间,术后48 h内各时间点的镇痛镇静评分、呼吸循环指标以及术后呕吐发生情况.结果 两组患者术后拔管时间、术后各时间点镇静评分、呼吸频率、平均动脉压、心率及呕吐发生率比较差异均无统计学意义(P>0.05).术后30 min和1、2、4、6及12h时间点,Ⅰ

  13. Ethanol-induced analgesia

    Pohorecky, L.A.; Shah, P.


    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  14. Early recovery after abdominal rectopexy with multimodal rehabilitation

    Basse, Linda; Billesbølle, Per; Kehlet, Henrik


    status III to IV, were scheduled for abdominal rectopexy with a multimodal rehabilitation program including 48 hours thoracic epidural analgesia or patient-controlled anesthesia (3 patients), early oral nutrition and mobilization, and a planned two-day postoperative hospital stay. Follow-up was done at......PURPOSE: Abdominal rectopexy without sigmoid resection is usually associated with a hospital stay of four to ten days. Recent developments have shown that a multimodal rehabilitation program with epidural analgesia and early oral feeding and mobilization will reduce hospital stay after colonic...

  15. Minilaparotomy under acupuncture analgesia.

    Dias, P L; Subramanium, S


    Minilaparotomy was performed using acupuncture analgesia on 78 female patients seeking voluntary sterilization to determine whether this could be used as a substitute for standard analgesic sedation. In 48 women (62%) no intravenous drug medication was required, and sterilization was successfully performed using only the local anaesthetic and acupuncture electrostimulation. These patients could be discharged within one hour of operation. For a developing country with a shortage of trained ana...

  16. Epidural analgesia during labor vs no analgesia: A comparative study

    Wesam Farid Mousa


    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  17. Analgesia adjuvante e alternativa

    Vale Nilton Bezerra do


    JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA) podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal no...

  18. Estratégias da medicina preventiva de Geoffrey Rose

    Armando Henrique Norman


    Uma das atividades dos profissionais de saúde na prática dos serviços de atenção primária envolve a prevenção de doenças e a promoção da saúde. Essas atividades têm sido fortalecidas atualmente por meio de ações programáticas de saúde e manejo das doenças crônicas não transmissíveis. Esse contexto reforça a importância de se entenderem as bases da prevenção, discutidas no livro Estratégias da Medicina Preventiva de Geoffrey Rose.1 Rose classifica a prevenção de doenças em duas abordagens: a e...

  19. Multimodal Afslapning

    Stephen Palmer


    Full Text Available Artiklen beskriver Multimodal Relaxation Method (MRM, fremover Multimodal Afslapningsmetode, somkan anvendes i livs-, ledelses-, virksomheds-, sports- eller sundhedscoaching til at forbedre ydeevnen hos denenkelte og reducere eller håndtere stress. Inden for sports- og sundhedscoaching kan metoden anvendes til atreducere fysiske spændinger og styrke fysiologisk kontrol, fx lavere hjertefrekvens og nedsætte blodtrykket.

  20. 丙帕他莫复合舒芬太尼在老年患者全髋置换术后多模式镇痛中的效果%Effect of propacetamol combined with sufentanil for multimodal analgesia in aged patients after total hip replacement operation

    汪昊星; 王志萍; 王军; 顾正峰; 艾青


    目的:观察丙帕他莫复合舒芬太尼在老年患者全髋置换术后多模式镇痛中的效果及安全性。方法60例接受全髋置换术的老年患者,随机分成2组,分别为丙帕他莫复合舒芬太尼组(A组)与舒芬太尼组(B组),每组30例。 A组术后静脉自控镇痛( PCIA)配方:丙帕他莫8 g+舒芬太尼1μg/kg+10 mg托烷司琼+生理盐水,总量100 mL;B组PCIA配方:舒芬太尼2μg/kg+10 mg托烷司琼+生理盐水,总量100 mL。两组镇痛液负荷量5 mL, PCIA镇痛泵维持量1.8 mL/h,追加量0.5 mL,锁定时间15 min。观察术后4、8、12、24、48 h静息及活动时疼痛VAS评分、镇静Ramsay评分,记录镇痛泵药物消耗容量及自控按压次数,并记录不良反应。结果两组老年患者术后各时点静息及活动时镇痛评分比较差异无显著性意义,P>0.05;B组术后4、8、12 h Ramsay评分与A组比较差异有显著性意义,B组分别为3.17±0.95、3.23±0.90、3.13±0.82,A组分别为2.43±0.77、2.40±0.77、2.33±0.71,P<0.01;两组镇痛泵药物消耗容量及自控按压次数比较差异无显著性意义,P>0.05;镇痛期间不良反应发生率比较差异有显著性意义,恶心、头晕发生率B组分别为26.67%、23.33%,高于A组的6.67%、3.33%, P<0.05。结论丙帕他莫复合舒芬太尼用于老年患者全髋置换术后多模式镇痛安全有效,不良反应发生率低。%Objective To observe the analgesic efficacy and safety of propacetamol combined with sufentanyl for multimod -el analgesia in aged patients after total hip replacement operation .Methods Sixty aged patients undergoing total hip replace-ment operation were randomly divided into two groups , with 30 patients in each group:the propacetamol plus sufentanil group(group A) and the sufentanil group (group B).The composition of patient -controlled intravenous

  1. Remifentanil as analgesia for labour pain

    Tveit, Tor Oddbjørn


    Aims: To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil IVPCA (intravenous patient-controlled analgesia) for pain relief during labour. To compare remifentanil IVPCAwith epidural analgesia (EDA) regarding efficacy and safety during labour. Methods: In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study ...


    Bilić, Nada; Djaković, Ivka; Kličan-Jaić, Katarina; Rudman, Senka Sabolović; Ivanec, Željko


    Labor pain is one of the most severe pains. Labor is a complex and individual process with varying maternal requesting analgesia. Labor analgesia must be safe and accompanied by minimal amount of unwanted consequences for both the mother and the child, as well as for the delivery procedure. Epidural analgesia is the treatment that best meets these demands. According to the American Congress of Obstetrics and Gynecology and American Society of Anesthesiologists, mother's demand is a reason enough for the introduction of epidural analgesia in labor, providing that no contraindications exist. The application of analgesics should not cease at the end of the second stage of labor, but it is recommended that lower concentration analgesics be then applied. Based on the latest studies, it can be claimed that epidural analgesia can be applied during the major part of the first and second stage of labor. According to previous investigations, there is no definitive conclusion about the incidence of instrumental delivery, duration of second stage of labor, time of epidural analgesia initiation, and long term outcomes for the newborn. Cooperation of obstetric and anesthesiology personnel, as well as appropriate technical equipment significantly decrease the need of instrumental completion of a delivery, as well as other complications encountered in the application of epidural analgesia. Our hospital offers 24/7 epidural analgesia service. The majority of pregnant women in our hospital were aware of the advantages of epidural analgesia for labor, however, only a small proportion of them used it, mainly because of inadequate level of information. PMID:26666104

  3. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Aliya Ahmed


    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  4. Epidural analgesia for cardiac surgery

    V. Svircevic; M.M. Passier; A.P. Nierich; D. van Dijk; C.J. Kalkman; G.J. van der Heijden


    Background A combination of general anaesthesia (GA) with thoracic epidural analgesia (TEA) may have a beneficial effect on clinical outcomes by reducing the risk of perioperative complications after cardiac surgery. Objectives The objective of this review was to determine the impact of perioperativ

  5. Una estrategia preventiva para adolescentes con riesgo suicida y consumo de sustancias en el escenario escolar

    Emilia Lucio Gómez Maqueo; Mariana Linage Rivadeneyra; Marisol Pérez Ramos; Paulina Arenas Landgrave


    Debido al reciente aumento de consumo de drogas en adolescentes, es importante crear estrategias de prevención que estén a su alcance. El objetivo de este estudio fue diseñar, ejecutar y evaluar una estrategia preventiva con adolescentes estudiantes de bachillerato identificados en riesgo de consumo de sustancias y riesgo suicida a través de un tamizaje previo. La estrategia preventiva propuesta se basa en el modelo de evaluación colaborativa donde los terapeutas trabajan en colaboración con ...

  6. Estratégias da medicina preventiva de Geoffrey Rose

    Armando Henrique Norman


    Full Text Available Uma das atividades dos profissionais de saúde na prática dos serviços de atenção primária envolve a prevenção de doenças e a promoção da saúde. Essas atividades têm sido fortalecidas atualmente por meio de ações programáticas de saúde e manejo das doenças crônicas não transmissíveis. Esse contexto reforça a importância de se entenderem as bases da prevenção, discutidas no livro Estratégias da Medicina Preventiva de Geoffrey Rose.1 Rose classifica a prevenção de doenças em duas abordagens: a estratégia de alto risco (EAR e a estratégia de amplitude populacional (EAP. A primeira refere-se ao processo de separação entre os indivíduos de alto risco e os demais. A segunda visa abranger a população como um todo. A estratégia de alto risco parte de uma lógica binária de processo decisório que na medicina é denominada diagnose, ou seja, a pessoa tem ou não a condição a ser investigada. Em caso positivo, alguma intervenção lhe é oferecida; em caso negativo, ‘deixa-se a pessoa em paz’. A EAR é muito atrativa e, tradicionalmente, mais lógica e adequada: primeiro, porque faz sentido tanto aos profissionais como aos pacientes, visto que ambos entendem mais facilmente o porquê da intervenção; segundo, por ser custo-efetiva, pois os recursos são direcionados àqueles que mais precisam; finalmente, porque se encaixa mais no cotidiano dos serviços, que geralmente operam na lógica do modelo individual do cuidado às doenças.Existem, no entanto, algumas desvantagens desse tipo de intervenção: (1 tende-se a medicalizar a prevenção; (2 há que se manter o programa indefinidamente, pois não se intervém no problema de base; e (3 é difícil para aquele que recebe a intervenção quantificar seu real benefício, visto que se opera no campo da probabilidade (NNT: número necessário para tratar durante certo tempo para que uma pessoa se beneficie. Qual pessoa irá se beneficiar? Não sabemos. Porém, o

  7. Sensitivity of quantitative sensory models to morphine analgesia in humans

    Olesen AE


    Full Text Available Anne Estrup Olesen,1,2 Christina Brock,1,2 Eva Sverrisdóttir,2 Isabelle Myriam Larsen,1 Asbjørn Mohr Drewes1,3 1Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; 2Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Introduction: Opioid analgesia can be explored with quantitative sensory testing, but most investigations have used models of phasic pain, and such brief stimuli may be limited in the ability to faithfully simulate natural and clinical painful experiences. Therefore, identification of appropriate experimental pain models is critical for our understanding of opioid effects with the potential to improve treatment. Objectives: The aim was to explore and compare various pain models to morphine analgesia in healthy volunteers. Methods: The study was a double-blind, randomized, two-way crossover study. Thirty-nine healthy participants were included and received morphine 30 mg (2 mg/mL as oral solution or placebo. To cover both tonic and phasic stimulations, a comprehensive multi-modal, multi-tissue pain-testing program was performed. Results: Tonic experimental pain models were sensitive to morphine analgesia compared to placebo: muscle pressure (F=4.87, P=0.03, bone pressure (F=3.98, P=0.05, rectal pressure (F=4.25, P=0.04, and the cold pressor test (F=25.3, P<0.001. Compared to placebo, morphine increased tolerance to muscle stimulation by 14.07%; bone stimulation by 9.72%; rectal mechanical stimulation by 20.40%, and reduced pain reported during the cold pressor test by 9.14%. In contrast, the more phasic experimental pain models were not sensitive to morphine analgesia: skin heat, rectal electrical stimulation, or rectal heat stimulation (all P>0.05. Conclusion: Pain models with deep tonic stimulation including C fiber activation

  8. Analgesia combinada vs analgesia peridural para trabajo de parto

    Juan Pablo Aristizábal


    Full Text Available Introducción: Las ventajas de la analgesia epidural-espinal incluyen una identificación confiable del espacio subaracnoideo, requerimiento de poco fármaco, disminución de toxicidad sistemica y analgesia de instauración rápida. En este estudio se comparan las técnicas peridural y epidural-espinal. Materiales y Métodos: Se incluyeron 200 pacientes en un periodo de 12 meses. Los criterios de inclusión fueron mujeres en trabajo de parto con dilatación mayor o igual a 5 cm sin patologías asociadas. Se evalúo la respuesta analgésica a los 5 y 15 minutos, la respuesta hemodinamica, bloqueo motor, efectos adversos y respuesta fetal. La técnica peridural se realizo con bupivacaina al 0.065% y la técnica epidural-espinal con fentanyl 25mcg intratecales sin anestésico local. Resultados : Cada grupo incluyó 100 pacientes (peridural o analgesia A y epidural-espinal o analgesia B. La percepción de dolor fue similar en ambos grupos a los 5 minutos (p value = 0.291, a los 15 minutos fue menor con analgesia epidural-espinal (p value = 0.008. No hubo cambios hemodinamicos ni bloqueo motor ni diferencia fetal en ambos grupos. Se encontró una incidencia de prurito con la técnica epidural-espinal de 36%. Conclusión: La analgesia epidural-espinal con opioides intratecales produce mayor disminución en la percepción del dolor a los 15 minutos comparado con la peridural, sin presentar cambios hemodinamicos ni bloqueo motor y sin alteración en el recién nacido, con una incidencia de 36% de prurito.Backround: The advantage of epidural-spinal analgesia technique include better subaracnoid space identification, less drug requirements, less sistemic toxicity, and rapid analgesic effect. In this study we compare peridural and peridural-spinal tecnique. Methods: The study included 200 patients during a period of 12 months. The inclusion criteria were women during labour with dilatation of 5cm or more without any associated pathology. The study evaluate

  9. Cetamina e analgesia preemptiva Cetamina y analgesia preemptiva Ketamine and preemptive analgesia

    Caio Márcio Barros de Oliveira


    Full Text Available JUSTIFICATIVA E OBJETIVOS: Desde a descoberta de que a cetamina bloqueia os receptores NMDA nos neurônios do corno dorsal da medula, ela tem sido usada para inibir ou reduzir a sensibilização central provocada por estímulos nociceptivos. Assim, este trabalho visa mostrar aspectos farmacológicos da cetamina racêmica e de seu composto levogiro e seu emprego na analgesia preemptiva. CONTEÚDO: São apresentados conceitos atuais sobre analgesia preemptiva, aspectos farmacológicos da cetamina e seu derivado levogiro, bem como estudos experimentais e clínicos sobre a cetamina e seu uso em analgesia preemptiva. CONCLUSÕES: Ainda não está totalmente comprovada a eficácia da cetamina em inibir ou reduzir a sensibilização central provocada por estímulos nociceptivos. Provavelmente isso se deva ao uso de diferentes métodos de estudo e de análise estatística.JUSTIFICATIVA Y OBJETIVOS: Desde la descubierta de que la cetamina bloquea los receptores NMDA en los neuronios del cuerno dorsal de la médula, ella ha sido usada para inhibir o reducir la sensibilización central provocada por estímulos nociceptivos. Así, este trabajo tiene por finalidad mostrar aspectos farmacológicos de la cetamina racemica y de su compuesto levogiro y su empleo en la analgesia preemptiva. CONTENIDO: Se presentan conceptos actuales sobre analgesia preemptiva, aspectos farmacológicos de la cetamina y su derivado levogiro, bien como estudios experimentales y clínicos sobre la cetamina y su uso en analgesia preemptiva. CONCLUSIONES: Aun no está totalmente comprobada la eficacia de la cetamina en inhibir o reducir la sensibilización central provocada por estímulos nociceptivos. Probablemente eso se deba al uso de diferentes métodos de estudio y de análisis estadística.BACKAGROUND AND OBJECTIVES: Since the finding that ketamine blocks NMDA receptors in the neurons of spinal dorsal horn, it has been used to inhibit or decrease central sensitization triggered

  10. Crónica: Diplomado de Medicina Preventiva Veterinaria en Pinar del Río

    Antúnez, G.(; Rodríguez, Y; Ramírez, W; Flores, A.; Jesús Moreno


    Nuevamente la Universidad de Granma y se unen en un proyecto de capacitación, está vez el escenario fue el Consejo Científico de Veterinaria de Pinar del Río, Cuba, donde docentes de ambas instituciones desarrollan exitosamente, por primera vez, un Diplomado a distancia en Medicina Preventiva Veterinaria.

  11. Tres perspectivas del acoso moral en el trabajo: psicológica, jurisprudencial y preventiva

    Escudero García, Javier


    El acoso moral en el trabajo es un fenómeno muy común en las organizaciones empresariales. Lo que se intenta en este trabajo es analizar y estudiar dicho fenómeno desde tres perspectivas completamente distintas pero a la vez interrelacionadas entre si (psicológica, jurisprudencial y preventiva).

  12. Efficiency and safety of multimodal analgesia use in nasal endoscope operation with the compound of sufentanil with parecoxib sodium through nose%舒芬太尼经鼻给药复合帕瑞昔布钠用于鼻内窥镜术后镇痛

    施震; 陈敏; 王庆利; 陶军


    Objective To observe the efficiency and safety of multimodal analgesia use in nasal endoscope operation with the compound of sufentanil with parecoxib sodium through nose. Meathods Sixty nasal endoscope operation patients were divided into three groups randomly. Group A was S1 group, 2 μg sufentanil was administered through nose after operation, and 40 mg parecoxib sodium was injected. Group B was S2 group, 15 μg sufentanil was administered through nose after operation, and 40 mg parecoxib sodium was injected. Group C was administered physiological saline through nose after operation, and was injected with 40 mg parecoxib sodium. Systolic pressure(SBP), diastolic pressure(DBP), mean arterial pressure (MAP) and heart rate (HR) were recorded respectively immediately at operation (T0) ,10 minutes before extubation(T1), extubation (T2) and 10 minutes after extubation(T3). And visual pain analog scale (VAS) was recorded respectively 10 minutes after anesthesia for awake after extubation, 4 hours after operation, 12 hours after operation and 24 hours after operation. Adverse reaction 24 hours after operation was recorded as well. Results SBP, DBP, MAP and HR of group S1 and group S2 at the moment of T2 and T3 were obviously lower than group C (P<0.05). Visual pain analog scale of group S1 at each moment was obviously better than group C (P < 0. 05). Conclusion Twenty - fiveμg sufentanil through nose after operation combined with injection of 40 mg parecoxib sodium can relieve pain after operation noticeably and safely.%目的 观察舒芬太尼经鼻给药复合帕瑞昔布钠多模式镇痛在鼻内窥镜手术后的镇痛效果及安全性.方法 选择择期行鼻内窥镜手术的患者60例,随机分成3组,S1组,术毕经鼻腔给予舒芬太尼25 μg,并静注帕瑞昔布钠40mg;S2组,术毕经鼻腔给予舒芬太尼15 μg,并静注帕瑞昔布钠40mg;C组,术毕经鼻腔给予生理盐水,并静注帕瑞昔布钠40 nmg.分别于术毕即刻(T0)、拔管前10

  13. Sedation and Analgesia in Interventional Radiology

    Tuite, Catherine; Rosenberg, Eric J.


    Complex medical procedures requiring the administration of sedation and analgesia are frequently performed in sites outside the operating room. In particular, interventional radiologists must understand basic principles of sedation and analgesia to direct nurses or nurse practitioners to provide adequate conscious sedation. The purpose of this article is to review basic principles of sedation, pharmacologic agents used for sedation and analgesia, practice guidelines, monitoring, and managemen...

  14. Epidural labour analgesia using Bupivacaine and Clonidine

    Syal, K; R K Dogra; A Ohri; Chauhan, G.; Goel, A.


    Background: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. Patients & Methods: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacain...

  15. Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

    Tarek AbdElBarr


    Conclusions: Based on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia.

  16. Acupoint stimulation to improve analgesia quality for lumbar spine surgical patients.

    Chung, Yu-Chu; Chien, Hui-Ching; Chen, Hsing-Hsia; Yeh, Mei-Ling


    Lumbar spine surgery has a high incidence of postoperative pain, but this pain is treatable through many methods, including patient-controlled analgesia (PCA). Acupoint stimulation could be considered an adjunct to PCA, improving the effectiveness of analgesia for patients recovering from lumbar spine surgery. The current study aimed to examine the effect of acupoint stimulation with PCA on improving analgesia quality after lumbar spine surgery. A single-blinded, sham-controlled design was used for the experimental, not control, groups. Data collection for the control group was completed first, followed by data collection for the other 2 groups. Participants were randomly assigned to the acupoint stimulation (AS) (n = 45) or sham group (n = 45). All participants received structural PCA multimedia information before lumbar surgery. The AS group received auricular acupressure combined with transcutaneuos electric acupoint stimulation (TEAS) at the true acupoint; the sham group received acupoint stimulation in the same manner but at a sham acupoint and without embedding seeds; and the control group received no acupoint stimulations. The analgesia quality, analgesic consumption, and postoperative nausea and vomiting (PONV) were used as measure of effects for the interventions. Significant differences were found between the AS and control groups in pain intensity but not in the belief and satisfaction subscales of analgesia quality. Also found a significant difference among the 3 groups in analgesic consumption and the severity of PONV in the first 72 hours after surgery. The current study shows that the combination of auricular acupressure and TEAS reduced pain intensity, morphine consumption, and PONV severity. Acupoint stimulation could be considered a multimodal analgesia method and an adjunct to PCA for lumbar spine surgery patients. PMID:24144572

  17. Sucrose ingestion causes opioid analgesia

    Segato F.N.


    Full Text Available The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean ± SEM, N = 12 for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 ± 0.04, 0.10 ± 0.05, 0.15 ± 0.08 and 0.49 ± 0.07, respectively. One-way ANOVA indicated a significant difference (F(3,47 = 9.521, P<0.001 and the Tukey multiple comparison test (P<0.05 showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7 receiving sucrose exhibited an analgesia index of 0.20 ± 0.10 while rats receiving only sucrose (N = 7 had an index of 0.68 ± 0.11 (t = 0.254, 10 degrees of freedom, P<0.03. This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.

  18. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

    Nilton Bezerra do Vale


    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  19. An evaluation of obstetrical analgesia.

    FIST, H S


    Relief of pain and safety of mother and child are fundamentals in obstetrical analgesia. Elimination of those drugs which are ineffective or dangerous is the best guide to proper medication. Morphine, codeine, or similar opium derivatives should be avoided as they depress fetal respiration. Barbiturates have the same fault, despite their popularity. Demerol in small dosage is safe and effective. Scopolamine yields excellent results with safety. Magnesium sulfate potentiates and reinforces the action of scopolamine and involves no danger. This combination of drugs may be used by any competent general practitioner in the home or hospital. PMID:13126811

  20. Guías preventivas por ciclo vital individual en Colombia

    Carlos Andrés Pineda


    Las guías preventivas son una condensación de las diferentes intervenciones en promoción de la salud y prevención de la enfermedad que se hacen para intervenir las poblaciones. Contienen estrategias de consejería, filtrado y medidas específicas de protección. Se menciona las características de una prueba de cribado. Se presentan las guías preventivas por cada ciclo vital individual en cuanto a medidas de consejería, protección específica y filtro. Así, se ofrece una guía concreta sobre las ...

  1. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

    Nilton Bezerra do Vale


    JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA) podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal no...

  2. Paediatric analgesia in an Emergency Department.

    Hawkes, C


    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  3. Ketamine hydrochloride - an adjunct for analgesia in dogs with burn wounds : clinical communication

    K. Joubert


    Full Text Available The management of pain in patients with burn wounds is complex and problematic. Burn-wound pain is severe, inconsistent and underestimated. Patients experience severe pain, especially during procedures, until wound healing has occurred. A multi-modality approach is needed for effective management of pain, which requires an understanding of the mechanisms of pain. Altered pharmacokinetics and pharmacodynamics in burn-wound patients makes drug actions unpredictable. Opioids alone are seldom sufficient for pain control. The multi-modality approach includes the use of opioids and non-steroidal antiinflammatory, anxiolytic and alternative drugs. Ketamine has been found to be a useful agent for analgesia in burn-wound patients; a dose of 10 mg/kg qid per os was found to be an effective adjunct to pain therapy.

  4. Intranasal sufentanil/ketamine analgesia in children

    Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne;


    The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

  5. The experience of labour with epidural analgesia

    Jepsen, Ingrid; Keller, Kurt Dauer


    important finding refers to the labouring woman’s relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance. Conclusion...... birth. Findings: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another......: After initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman’s type of emotional reaction to epidural analgesia and her possible intricate worries. 2014 Australian...

  6. Analgesia and Sedation After Pediatric Cardiac Surgery


    Abstract In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery, has become recognised as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast track and ultra fast track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric in...

  7. Partial reinforcement, extinction, and placebo analgesia

    Yeung, Siu Tsin Au; Colagiuri, Ben; Lovibond, Peter F.; Colloca, Luana


    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electro-cutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) u...

  8. Analgesia pós-operatória Postoperative analgesia

    Betina Sílvia Beozzo Bassanezi


    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A dor sempre foi uma das maiores preocupações do homem, entretanto, apesar dos progressos da ciência, ainda existem várias barreiras ao seu adequado tratamento, incluindo a falta de conhecimento por parte da equipe médica, sobre o mecanismo das diversas drogas e técnicas empregadas. O objetivo deste trabalho é abordar as principais drogas e técnicas empregadas no controle da dor pós-operatória, visando estimular o interesse sobre o assunto bem como aumentar a eficácia do tratamento dado aos pacientes. CONTEÚDO: Está ressaltada neste artigo, a importância da adequada analgesia pós-operatória, considerando as principais drogas e técnicas utilizadas no controle da dor, seus mecanismos de ação, posologias, vias de administração e efeitos colaterais, bem como a importância da integração de toda a equipe envolvida nos cuidados do paciente para o sucesso do tratamento. O tratamento inadequado da dor no pós-operatório não se justifica, pois há um arsenal considerável de drogas e técnicas analgésicas. O que se faz necessário, portanto, é que toda equipe, anestesistas, cirurgiões, e enfermeiros tenham conhecimento e estejam integrados na utilização deste arsenal.BACKGROUND AND OBJECTIVES: Pain has been one of the men's biggest worries. Despite of scientific progress there still exist many barriers in an adequate treatment of pain including the lack of knowledge of many drugs and pain management techniques. The objective of this study is to discuss the main drugs and analgesics process in an effort to stimulate our colleague interest about the subject and thus increasing treatment efficiency of our patients. CONTENTS: It is emphasized in this study the importance of an adequate postoperative analgesia discussing the main drugs and techniques used in pain management, their mechanism of action, dose, administration route and side effects of each drug. It is also pointed out the great importance

  9. Medidas preventivas, correctoras y compensatorias del impacto ecológico de carreteras

    Aizpurúa Giráldez, Nerea


    Las medidas preventivas, correctoras y compensatorias empleadas en los proyectos de carretera son uno de los elementos clave para conseguir la integración ambiental de estas infraestructuras. De ellas dependerá que los posibles impactos ambientales generados durante su construcción y explotación no supongan un detrimento inadmisible de la calidad ambiental. La tipología de medidas que se vienen aplicando desde hace más de veinte años en durante el proceso de Evaluación de Impacto Ambiental (E...

  10. Concepto de adherencia preventiva en el ámbito de las adicciones

    García del Castillo Rodríguez, José Antonio; García del Castillo López, Álvaro; López Sánchez, Carmen


    A pesar de llevar varias décadas desarrollando el campo de la prevención de las adicciones, a día de hoy aún seguimos configurando su marco conceptual. En este trabajo se pretende dar un paso más en su construcción intentando concretar a nivel teórico el proceso de adherencia en el ámbito preventivo. Partiendo del supuesto teórico en la relación del concepto de adherencia con diferentes procesos psicológicos básicos, se plantea la estructura de la adherencia preventiva desde diferentes modelo...

  11. Aportaciones de la medicina preventiva y salud pública a la seguridad del paciente

    Aranaz Andrés, Jesús María


    La esencia de la Salud Pública es la vigilancia. Detrás da cada avance científico de la medicina hay una observación, un análisis y una toma de decisiones consecuencia de éste. La Salud Pública persigue proteger a la población minimizando los riesgos que amenazan su salud, mientras que la Medicina Preventiva intenta identificar los grupos de población que son especialmente vulnerables a riesgos específicos, para desarrollar estrategias concretas a ellos destinadas. Ambas utiliz...

  12. Odontología preventiva en el paciente geriátrico

    Velasco-Ortega, Eugenio; Machuca-Portillo, Guillermo; Martinez-Sahuquillo Marquez, Angel; Ríos-Santos, J.V.; Bullon, Pedro


    El incremento de la población mayor de 65 años y sus necesidades crecientes de tratamiento oral, está modificando el desarrollo de una filosofía preventiva odontológica para los pacientes de edad avanzada. Si queremos que los ancianos gocen de un buen estado de salud oral en la senectud, deben beneficiarse de los medios preventivos orales, actualmente a nuestro alcance. Debe prevenirse el edentulismo mediante un tratamiento integral y restaurador de las enfermedades dentales más frecuentes (c...

  13. Efficacy of trans abdominis plane block for post cesarean delivery analgesia: A double-blind, randomized trial

    Uma Srivastava


    Full Text Available Background: The transverse abdominis plane (TAP block, a regional block provides effective analgesia after lower abdominal surgeries if used as part of multimodal analgesia. In this prospective, randomized double-blind study, we determined the efficacy of TAP block in patients undergoing cesarean section. Materials and Methods: Totally, 62 parturients undergoing cesarean section were randomized in a double-blind manner to receive either bilateral TAP block at the end of surgery with 20 ml of 0.25% bupivacaine or no TAP block, in addition to standard analgesic comprising 75 mg diclofenac 8 hourly and intravenous patient-controlled analgesia (PCA tramadol. Each patient was assessed at 0, 4, 8, 12, 24, 36, and 48 h after surgery by an independent observer for pain at rest and on movement using numeric rating scale of 0-10, time of 1 st demand for tramadol, total consumption of PCA tramadol, satisfaction with pain management and side effects. Results: Use of tramadol was reduced in patients given TAP block by 50% compared to patients given no block during 48 h after surgery (P < 0.001. Pain scores were lower both on rest and activity at each time point for 24 h in study group (P < 0.001, time of first analgesia was significantly longer, satisfaction was higher, and side effects were less in study group compared to control group. Conclusion: Transverse abdominis plane block was effective in providing analgesia with a substantial reduction in tramadol use during 48 h after cesarean section when used as adjunctive to standard analgesia.

  14. Multimodal Emotion Recognition Using Multimodal Deep Learning

    Liu, Wei; Zheng, Wei-Long; Lu, Bao-Liang


    To enhance the performance of affective models and reduce the cost of acquiring physiological signals for real-world applications, we adopt multimodal deep learning approach to construct affective models from multiple physiological signals. For unimodal enhancement task, we indicate that the best recognition accuracy of 82.11% on SEED dataset is achieved with shared representations generated by Deep AutoEncoder (DAE) model. For multimodal facilitation tasks, we demonstrate that the Bimodal De...

  15. Towards Multimodal Content Representation

    Bunt, Harry


    Multimodal interfaces, combining the use of speech, graphics, gestures, and facial expressions in input and output, promise to provide new possibilities to deal with information in more effective and efficient ways, supporting for instance: - the understanding of possibly imprecise, partial or ambiguous multimodal input; - the generation of coordinated, cohesive, and coherent multimodal presentations; - the management of multimodal interaction (e.g., task completion, adapting the interface, error prevention) by representing and exploiting models of the user, the domain, the task, the interactive context, and the media (e.g. text, audio, video). The present document is intended to support the discussion on multimodal content representation, its possible objectives and basic constraints, and how the definition of a generic representation framework for multimodal content representation may be approached. It takes into account the results of the Dagstuhl workshop, in particular those of the informal working group...

  16. Multimodality and CALL

    Guichon, Nicolas; Cohen, Cathy


    This chapter explores the issues pertaining to multimodality, which has always been considered as a defining characteristic of CALL (Chapelle 2009). The chapter begins by critically examining the various definitions of multimodality, especially in the field of second language acquisition and cognitive psychology and explores the distinction between mode, modality and channel. With reference to specific studies conducted in the field, we then investigate the potential of multimodality for seco...

  17. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Freeman Liv M


    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  18. Pain analgesia among adolescent self-injurers.

    Glenn, Jeffrey J; Michel, Bethany D; Franklin, Joseph C; Hooley, Jill M; Nock, Matthew K


    Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12-19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem. PMID:25172611

  19. Effect of postoperative epidural analgesia on surgical outcome

    Holte, K; Holte, Kathrine


    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is...

  20. Potentiation of morphine analgesia by caffeine.

    Misra, A L; Pontani, R B; Vadlamani, N L


    Significant potentiation of morphine (5 mg kg-1 s.c. or 1 mg kg-1 i.v.) analgesia (tail-withdrawal reflex at 55 degrees C) was observed in caffeine-treated (100 mg kg-1 i.p.) rats as compared to the control group and lower doses of caffeine (2mg kg-1 i.p.) did not show this effect. Potentiated analgesia was reversed by naloxone. Pharmacokinetic or dispositional factors appear to be involved in part in this potentiation. PMID:4005485

  1. Potentiation of morphine analgesia by caffeine.

    Misra, A. L.; Pontani, R. B.; Vadlamani, N. L.


    Significant potentiation of morphine (5 mg kg-1 s.c. or 1 mg kg-1 i.v.) analgesia (tail-withdrawal reflex at 55 degrees C) was observed in caffeine-treated (100 mg kg-1 i.p.) rats as compared to the control group and lower doses of caffeine (2mg kg-1 i.p.) did not show this effect. Potentiated analgesia was reversed by naloxone. Pharmacokinetic or dispositional factors appear to be involved in part in this potentiation.

  2. Nerve injury caused by mandibular block analgesia

    Hillerup, S; Jensen, Rigmor H


    : feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than......Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed...

  3. Fundamentos de la detención preventiva en el procedimiento penal colombiano

    Leonardo Cruz Bolívar


    Full Text Available La contribución se ocupa de analizar en concreto los principios que rigen la privación preventiva de la libertad en el procedimiento penal, desde el punto de vista constitucional, legal y de instrumentos internacionales, buscando armonizar los criterios que utilizan los jueces de garantías al momento de resolver la solicitud del fiscal en esta materia. El principio de proporcionalidad constitucional, los elementos desarrollados legalmente y los pronunciamientos del sistema interamericano de derechos humanos dan base a las interpretaciones que se proponen en el artículo, buscando proteger la libertad, sin renunciar a las necesidades básicas de la justicia y la sociedad que requieren un proceso penal eficiente y que responda a la realidad nacional.

  4. Estados Unidos-Medio Oriente: de la contención a la guerra preventiva

    Zeraoui, Zidane


    La política norteamericana hacia el Medio Oriente ha transitado desde la doctrina de la contención, aplicada por el presidente Truman a partir de 1948 para detener la supuesta expansión comunista, y vigente hasta la caída de la Unión Soviética, a la guerra preventiva iniciada por el presidente George W. Bush a partir de septiembre de 2002. Entre estas dos políticas, durante la década de los años noventa, Washington ha elaborado la doctrina de la doble contención, específicamente en relación a...

  5. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D; Porath, Martina; Berg, Hans J. van den; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A.H.M.; Logtenberg, Sabine L M


    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women....

  6. Critical Analysis of Multimodal Discourse

    van Leeuwen, Theo


    This is an encyclopaedia article which defines the fields of critical discourse analysis and multimodality studies, argues that within critical discourse analysis more attention should be paid to multimodality, and within multimodality to critical analysis, and ends reviewing a few examples...... of recent work in the critical analysis of multimodal discourse....

  7. Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

    Gabriela Carvalho Aquilino Santos


    Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received of epidural morphine. Thirty minutes after premedication, of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

  8. Multimodal Processes Rescheduling

    Bocewicz, Grzegorz; Banaszak, Zbigniew A.; Nielsen, Peter;


    -cuted in these kinds of systems can be considered using a declarative modeling framework. Proposed representation provides a unified way for performance evaluation of local cyclic as well as supported by them multimodal processes. The main question regards of reachability of a SCCP cyclic behavior. In this context......Cyclic scheduling problems concerning multimodal processes are usually observed in FMSs producing multi-type parts where the Automated Guided Vehicles System (AGVS) plays a role of a material handling system. Schedulability analysis of concurrently flowing cyclic processes (SCCP) exe......, the sufficient conditions guarantee the reachability of both local and multimodal processes cyclic steady state spaces are discussed....

  9. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice

    Kehlet, H; Andersen, L Ø


    Relief of acute pain after hip and knee replacement represents a major therapeutic challenge as post-operative pain hinders early mobilisation and rehabilitation with subsequent consequences on mobility, duration of hospitalisation and overall recovery. In recent years, there has been increased...... interest in high-volume local wound infiltration/infusion techniques in these operations with a combined administration of local anaesthetics, NSAIDs and epinephrine. This review provides an update of the current knowledge of the efficacy of the high-volume wound infiltration technique based on randomised...... either intraoperatively or with a post-operative wound infusion catheter technique, provided that multimodal, oral non-opioid analgesia is given. In knee replacement, the data support the intraoperative use of the local infiltration technique but not the post-operative use of wound catheter...

  10. Wound catheter techniques for postoperative analgesia



    Wound catheter technique is a technique of postoperative analgesia in which the surgeon places a catheter to infuse local anesthetic into wounds at the end of the procedure. It can be used in abdominal colorectal surgery or after holecystectomies, was studied after caesarean delivery. It was effective after some orthopaedic procedures such as shoulder and knee surgery, at the donor site in the iliac crest. It can be used in plastic surgery after breast surgery. It is technically efficie...

  11. Continuous subcutaneous pethidine for routine postoperative analgesia.

    Davenport, H T; Al-Khudairi, D.; Cox, P. N.; Wright, B. M.


    We consider that the present state of postoperative analgesia is unsatisfactory because drugs are given intermittently and usually only at the patients' request and with nurses' acquiescence. A procedure for routine continuous pethidine infusion, suitable for administration and control by the nursing staff is described. The results of a trial on patients after major surgery are summarised. We believe the procedure to be more efficient and effective than those presently in use.

  12. [Labor analgesia in the US and Japan].

    Morishima, Hisayo O


    Obstetric anesthesia has made significant progress over the last 50 years. It is one of the major subspecialties in anesthesia in US. Society for Obstetric Anesthesia and Perinatology (SOAP) was founded in 1968. According to its SCORE project on the practice of obstetric anesthesia, 82.4% of all parturients received some form of anesthesia for cesarean section or labor analgesia. Epidural analgesia was the most common form of labor analgesia (65%), followed by CSEA. This high percentage of anesthesia care for parturients mandates the presence of obstetric anesthesiologists at labor and delivery suites in major hospitals in US. The Japanese Society of Obstetrics and Anesthesia, formerly "Mutsu-bunben Kenkyukai", now called "Bunben to Masui Kenkyukai", was founded in Japan at about the same time as SOAP. Despite its long history, obstetric anesthesia is yet to be a major subspecialty in Japan. It is encouraging, however, that the number of attendants in obstetric anesthesia sessions in JSA seems increasing. SOAP has played an important role in the education and progress of obstetric anesthesia in US. I hope that the joint symposium of SOAP, Bunben to Masui Kenkyukai, and JSA at 39th SOAP annual meeting will facilitate the progress of obstetric anesthesia in Japan. PMID:17877044

  13. Intrathecal analgesia and palliative care: A case study

    Naveen S Salins


    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  14. Investigação Vacinal: uma ação preventiva em pacientes internados



    Full Text Available Este estudio tiene el objetivo de apuntar una relación entre servicio y ensiñanza, además de analizar la actuialización de las vacunas en los pacientes internados en el Instituto de Infectologia Emilio Ribas (IIER por el Centro de Inmunización, como una forma de acción preventiva para los pacientes internados. Fué hecho un analisis de las vacunas administradas en los pacientes internados en este instituto en el periodo de enero de 2002 hasta septiembre de 2003. Tal servicio fué realizado por empleados de este centro y aprendices de graduación en enfermeria. Fué obsevado, así que las preguntas fueron hechas por los aprendices de graduación de enfermeria, aumentaba el numero de las realizaciones de las mismas. Mientras que las actualizaciones de las vacunas atrasadas o en el momento cierto de su aplicación, no había aumentado de modo significante.

  15. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Florian Chouchou

    Full Text Available The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers. Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1 placebo analgesia improved with REM sleep deprivation; 2 pain relief expectations did not differ between REM sleep deprivation and control groups; and 3 REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.




    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  17. Multimodal Resources in Transnational Adoption

    Raudaskoski, Pirkko Liisa

    The paper discusses an empirical analysis which highlights the multimodal nature of identity construction. A documentary on transnational adoption provides real life incidents as research material. The incidents involve (or from them emerge) various kinds of multimodal resources and participants...

  18. Clinical Efficacy of Sustained-Release Buprenorphine with Meloxicam for Postoperative Analgesia in Beagle Dogs Undergoing Ovariohysterectomy

    Nunamaker, Elizabeth A; Stolarik, DeAnne F; Ma, Junli; Wilsey, Amanda S; Jenkins, Gary J; Medina, Chris L


    The goal of the current study was to compare the efficacy, adverse effects, and plasma buprenorphine concentrations of sustained-release buprenorphine (SRB) and buprenorphine after subcutaneous administration in dogs undergoing ovariohysterectomy. In a prospective, randomized, blinded design, 20 healthy adult female Beagle dogs underwent routine ovariohysterectomy and received multimodal analgesia consisting of meloxicam and one of two buprenorphine formulations. Dogs were randomly assigned to receive either SRB (0.2 mg/kg SC, once) or buprenorphine (0.02 mg/kg SC every 12 h for 3 d). Blinded observers assessed all dogs by using sedation scores, pain scores, temperature, HR, RR, and general wellbeing. Dogs were provided rescue analgesia with 0.02 mg/kg buprenorphine SC if the postoperative pain score exceeded a predetermined threshold. Blood samples were collected, and mass spectrometry was used to determine plasma buprenorphine concentrations. Data were analyzed with a linear mixed model and Tukey–Kramer multiple comparison. Age, body weight, anesthetic duration, surgical duration, sevoflurane concentration, and cardiorespiratory variables did not differ significantly between groups. Dogs in both formulation groups had comparable postoperative sedation and pain scores. One dog from each formulation group had breakthrough pain requiring rescue analgesia. Plasma buprenorphine concentrations remained above a hypothesized therapeutic concentration of 0.6 ng/mL for 136.0 ± 11.3 and 10.67 ± 0.84 h for SRB and buprenorphine, respectively. Based on the results of this study, multimodal analgesic regimens consisting of meloxicam and either buprenorphine or SRB are equally efficacious in managing pain associated with an ovariohysterectomy and show comparable side effects. PMID:25255072

  19. Epidural analgesia in labor: specific characteristics, dilemmas and controversies

    Kutlešić Marija


    Full Text Available Introduction. Epidural analgesia has become the most popular method for labor pain relief. Analgesia in Labor: Yes or No? Labor pain is a complex phenomenon with sensory, cognitive, motivational, emotional, social, and cultural variables. Pain and anxiety lead to adrenergic hyperactivity, hyperventilation, hypocapnia with reduced uteroplacental blood flow and uncoordinated uterine activity, so pain relief is recommended and even indicated in cases of maternal comorbidity. Analgesia in Labor: Method of Choice. The quality of epidural analgesia is better than the one achieved by parenteral or inhalation agents, with increased uteroplacental blood flow and improved fetal-maternal oxygenation. Epidural Analgesia in Labor: What is Specific? The increased weight, lumbar lordosis, soft tissue edema and engorgement of epidural veins make it more difficult to perform epidural block in pregnancy. Epidural puncture should be performed by medial approach, at L2 - 3 or L3 - 4 level by loss of resistance technique between contractions. Epidural Analgesia in Labor: What With? Local anesthetics, bupivacaine, levobupivacaine, ropivacaine, are used and they can be combined with small doses of opioids (fentanyl or sufentanyl. Epidural Analgesia in Labor: How? Available techniques are epidural, spinal and combined spinal - epidural analgesia. Epidural Analgesia in Labor: Controversies. The most important controversy is the influence of epidural analgesia on operative or instrumental delivery rate. Low concentrations of local anesthetic in combination with small doses of opioids, together with active management of labor by an obstetrician, would lead to increased spontaneous delivery rate. Conclusion. Although there still are some difficulties, complications and controversies, epidural analgesia provides safe and effective labor pain control.

  20. Broadband multimode fiber spectrometer

    Liew, Seng Fatt; Choma, Michael A; Tagare, Hemant D; Cao, Hui


    A general-purpose all-fiber spectrometer is demonstrated to overcome the trade-off between spectral resolution and bandwidth. By integrating a wavelength division multiplexer with five multimode optical fibers, we have achieved 100 nm bandwidth with 0.03 nm resolution at wavelength 1500 nm. An efficient algorithm is developed to reconstruct the spectrum from the speckle pattern produced by interference of guided modes in the multimode fibers. Such algorithm enables a rapid, accurate reconstruction of both sparse and dense spectra in the presence of noise.

  1. Intrathecal Neostigmine Use For Postoperative Analgesia

    Tarkan Öztürk


    Full Text Available This study aims at evaluating postoperative analgesic efficacy and safety of intrathecal neostigmine doses in patients under hemispinal anesthesia. After Ethics Committee approval, 48 patients sheduled for elective arthroscopic surgery.patients were randomly divided into four groups. Hemispinal block technique was performed at the lateral decubitis position. Group I received 1.4 ml hyperbaric bupivacaine plus 12.5 µg neostigmine, Group II received 1.4 ml hyperbaric bupivacaine plus 25 µg neostigmine, Group III received 1.4 ml hyperbaric bupivacaine plus 50 µg neostigmine, Group IV (control received 1.4 ml hyperbaric bupivacaine plus 0.1 ml saline. Tramadol was used for analgesia during postoperative period. Hemodynamic and respiratorial changes, time to first rescue analgesics, postoperative tramadol consumption, and advers effects were assessed. Neostigmine at these doses was found to have no effect on hemodynamic or respiratory parameters. The time first rescue analgesics were 273±47 minutes in GI, 595±47 minutes in GII, 869±49 minutes in GIII, 190±4 minutes in GIV. Postoperative tramadol consumtion in neostigmin groups was defined low in meaningful degree when compared to the control group. None of the patients in GIV had postoperative nausea-vomiting. Postoperative nausea-vomiting incidences were 8.3% (1 patient in GI, 33.3% In this study it was concluded that intrathecal neostigmine produce a dose-dependent analgesia and dose-dependent incidence of adverse effects with doses studied. Neostigmine 12.5 µg dosage was enough for providing comfortable postoperative analgesia with low adverse effect.

  2. Ultrasound-guided continuous adductor canal block for analgesia after total knee replacement

    Zhang Wei; Hu Yan; Tao Yan; Liu Xuebing; Wang Geng


    Background There are several methods for postoperative analgesia for knee surgery.The commonly utilized method is multimodal analgesia based on continuous femoral nerve block.The aim of this study was to investigate the application of continuous adductor canal block for analgesia after total knee replacement and compare this method with continuous femoral nerve block.Methods Sixty patients scheduled for total knee replacement from June 2013 to March 2014 were randomly divided into a femoral group and an adductor group.Catheters were placed under the guidance of nerve stimulation in the femoral group and under the guidance of ultrasound in the adductor group.Operations were performed under combined spinal and epidural anesthesia.After the operations,0.2% ropivacaine was given at a speed of 5 ml/h through catheters in all patients.Visual analogue scale (VAS) pain scores at rest and while moving were noted at 4,24,and 48 hours after the operation,and quadriceps strength was also assessed at these time-points.Secondary parameters such as doses of complementary analgesics and side effects were also recorded.Results There were no significant differences between the groups in VAS pain scores at rest or while moving,at 4,24,or 48 hours after the operation (P >0.05).At these time-points,mean quadriceps strengths in the adductor group were 3.0 (2.75-3.0),3.0 (3.0-4.0),and 4.0 (3.0-4.0),respectively,all of which were significantly stronger than the corresponding means in the femoral group,which were 2.0 (2.0-3.0),2.0 (2.0-3.0),and 3.0 (2.0-4.0),respectively (P <0.05).There were no significant differences between the groups in doses of complementary analgesics or side effects (P >0.05).X-ray images of some patients showed that local anesthetic administered into the adductor canal could diffuse upward and reach the femoral triangle.Conclusions Continuous adductor canal block with 0.2% ropivacaine could be used effectively for analgesia after total knee replacement

  3. Neonatal respiratory depression associated with epidural analgesia

    Alberto Gálvez Toro


    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  4. Spinal analgesia for advanced cancer patients: an update.

    Mercadante, Sebastiano; Porzio, Giampiero; Gebbia, Vittorio


    In the nineties, spinal analgesia has been described as an useful means to control pain in advanced cancer patients. The aim of this review was to update this information with a systematic analysis of studies performed in the last 10 years. 27 papers pertinent with the topic selected for review were collected according to selection criteria. Few studies added further information on spinal analgesia in last decade. Despite a lack of a clinical evidence, spinal analgesia with a combination of opioids, principally morphine, and local anesthetics may allow to achieve analgesia in patients who had been intensively treated unsuccessfully with different trials of opioids. Some adjuvant drugs such as clonidine, ketamine, betamethasone, meperidine, and ziconotide may be promising agents, but several problems have to be solved before they can be used in the daily practice. In complex pain situations, spinal analgesia should not be negated to cancer patients, and oncologists should address this group of patients to other specialists. PMID:21684173

  5. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.


    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  6. Policia Preventiva en la Región Central de México y el Modelo Gaditano de Seguridad Interior

    Yañez, Arturo


    El argumento central de Arturo Yáñez es que "la policía preventiva no es, jurídicamente, una fuerza pública" debido a que constitucionalmente, funciones de seguridad interior son adjudicadas a la Guardia Nacional (5). Yáñez sostiene que una de las principales causas de esta ambigüedad es la influencia del modelo de seguridad interior previsto en la Constitución de Cadiz (1812) sobre la Constitución Federal mexicana. La confusión conceptual en torno a la función judicial ha provocado que la po...

  7. Modificación del volumen-intensidad como medida preventiva de lesiones en fútbol sala

    Álvarez Medina, J.; Murillo Lorente, V.; Giménez Salillas, L.; Manonelles Marqueta, P.


    A lo largo de los años se han desarrollado distintas metodologías para controlar las cargas de entrenamiento y optimizar el rendimiento. La prevención de lesiones se ha convertido en uno de los grandes objetivos del cuerpo técnico. Algunos estudios plantean que variables como el volumen de trabajo, la intensidad y la frecuencia en su realización pueden ser la clave para lograrlo. El propósito de este trabajo es analizar en qué magnitud han influido las diferentes medidas preventivas adoptadas...

  8. Etiologija i preventiva metaboličnih poremećaja u mliječnih krava

    Bačić, Goran; Karadjole, Tugomir; Mačešić, Nino; Karadjole, Martina


    Za suhostaj, a naročito prijelazni period, karakteristične su velike promjene u endokrinom statusu krave. Ove promjene pripremaju kravu za porođaj i laktaciju. Krave u suhostaju metaboliziraju hranjive tvari za održanje bazalnog metabolizma, za rast i razvoj ploda, te za vlastiti rast i razvoj. Mješavina hrane i sadržaj hranjivih tvari utječu na količinu unosa suhe tvari u organizam u danima prije porođaja. Etiologija i hranidbena preventiva metaboličnih poremećaja kao što su zamašćena jetra,...

  9. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

    Sharma Munish


    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

  10. Adrenalina como coadyuvante epidural para analgesia postoperatoria Epinephrine as epidural adjuvant for postoperative analgesia

    B. Mugabure Bujedo


    Full Text Available La adrenalina ha sido ampliamente utilizada junto con anestésicos locales, tanto a nivel periférico como central, desde que Heinrich Braun fuera el pionero en experimentar con ella al inicio de 1900. Un siglo de uso atestigua su seguridad general como coadyuvante, a pesar de que todavía poseemos un conocimiento parcial de su modo de actuar, consiguiendo una prolongación del bloqueo nervioso, una reducción de las concentraciones plasmáticas de los anestésicos locales, una reducción del sangrado quirúrgico y una potenciación del efecto analgésico. El convencimiento durante largo tiempo de que la adrenalina muestra todos estos efectos beneficiosos, así como los negativos, únicamente por vasoconstricción, es demasiado simplista y actualmente insuficiente. El objetivo principal de esta revisión se centrará en demostrar como la adrenalina epidural es capaz de mejorar la analgesia postoperatoria cuando forma parte de una mezcla junto a bupivacaína o ropivacaína y fentanilo.Epinephrine has been combined with neuraxial and peripheral local anesthetics since Heinrich Braun first experimented with its use in the early 1900s. A century of use attests to the general safety of adjuvant epinephrine, yet we have only modest understanding of its intended effects, which include prolonging block duration, reducing plasma concentrations of local anesthetics, reducing surgical bleeding and intensifying anesthesia and analgesia. The long-held belief that epinephrine exerts most of these effects, including any associated complications, by causing vasoconstriction is doubtlessly too simplistic and has been recently challenged. The main part of this chapter will therefore focus on the advantages and disadvantages of epinephrine in epidural analgesia and on optimizing postoperative analgesia by adding epinephrine and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine.

  11. An Overview of Multimodal Biometrics

    P. S. Sanjekar; J. B. Patil


    Unimodal biometrics has several problems such as noisy data, intra class variation, inter class similarities, non universality and spoofing which cause this system less accurate and secure. To overcome these problems and to increase level of security multimodal biometrics is used. Multimodal biometrics makes the use of multiple source of information for personal authentication. Multimodal biometrics has becoming very popular now days since it is at the frontier of...

  12. Meningitis tras anestesia y analgesia espinal

    M. Robles Romero; M.A. Rojas Caracuel; C. del Prado Álvarez


    El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como...

  13. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

    Harsimran Singh


    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  14. Labor Epidural Analgesia and Breastfeeding: A Systematic Review.

    French, Cynthia A; Cong, Xiaomei; Chung, Keun Sam


    Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively. PMID:27121239

  15. Fetal circulation during epidural analgesia for caesarean section.

    Lindblad, A; Marsál, K; Vernersson, E; Renck, H


    Fetal blood flow was examined during epidural analgesia in six women with uncomplicated pregnancies undergoing elective caesarean section. A non-invasive, ultrasonic technique was used to measure blood flow in the fetal descending aorta and intra-abdominal part of the umbilical vein before induction of analgesia with etidocaine and bupivacaine and 15 and 30 minutes afterwards. No appreciable change in fetal blood flow was observed.

  16. Integrated Multimodal Transportation Dashboard

    Ana Zaiat


    Na área dos sistemas de transportes atualmente existem vários sistemas inteligentes que permitem a monitorização, controlo e outras funções relevantes para um dado tipo de transportes. Entretanto, o tratamento individualizado dos diferentes modos, não favorece a geração de políticas e mecanismos integrados de gestão de transporte multimodal; são pouquíssimas as soluções que juntam diferentes tipos de transportes numa só aplicação. Surgiu, portanto, a necessidade dum painel de monitorização mu...

  17. Simplified Multimodal Biometric Identification

    Abhijit Shete


    Full Text Available Multibiometric systems are expected to be more reliable than unimodal biometric systems for personal identification due to the presence of multiple, fairly independent pieces of evidence e.g. Unique Identification Project "Aadhaar" of Government of India. In this paper, we present a novel wavelet based technique to perform fusion at the feature level and score level by considering two biometric modalities, face and fingerprint. The results indicate that the proposed technique can lead to substantial improvement in multimodal matching performance. The proposed technique is simple because of no preprocessing of raw biometric traits as well as no feature and score normalization.

  18. Sedação e analgesia em terapia intensiva Sedación y analgesia en terapia intensiva Sedation and analgesia in intensive care

    Fábio Ely Martins Benseñor; Domingos Dias Cicarelli


    JUSTIFICATIVA E OBJETIVOS: A ansiedade e a dor podem causar maior desconforto e risco aumentado de complicações no pós-operatório de pacientes cirúrgicos, prolongando inclusive seu tempo de internação. O objetivo deste estudo foi revisar os conceitos de sedação e analgesia em terapia intensiva, atualizando os conhecimentos e permitindo a revisão das informações disponíveis na literatura, assim como os consensos já publicados. CONTEÚDO: Apresentamos separadamente a sedação e analgesia, revisan...

  19. Meningitis tras anestesia y analgesia espinal

    M. Robles Romero


    Full Text Available El objetivo de esta revisión es una puesta al día en la etiología, diagnóstico, profilaxis y tratamiento de la meningitis tras anestesia y analgesia espinales. Aunque es una complicación mayor de esta técnica y su incidencia es baja, cada vez son más frecuentes los casos publicados en la literatura médica. Según su etiología se les clasifica en meningitis sépticas, víricas y asépticas. Las meningitis sépticas son las más frecuentes, y en su etiología cada vez juega un papel más destacado como agente implicado el estreptococo salivarius. Como meningitis asépticas se clasifican aquellas en las que el cultivo de líquido cefalorraquídeo es negativo, con un periodo de latencia de síntomas inferior a seis horas, que pueden cursar con eosinofilia en el líquido cefalorraquídeo y unos niveles cercanos a la normalidad en la glucorraquia. Suelen tener buena respuesta y evolución con tratamiento antibiótico con vancomicina y cefalosporinas de tercera generación. Como profilaxis incidir en las medidas de asepsia, sobre todo en el uso de mascarilla facial para realizar la técnica, como práctica para disminuir la incidencia de gérmenes cuyo origen está en la cavidad oral y orofaringe. Asimismo podrían reducir la incidencia de meningitis las medidas de asepsia tales como el lavado de manos, uso de guantes y asepsia de la piel. La diferenciación entre meningitis séptica y aséptica se hará con mayor seguridad cuando se estandaricen las técnicas para detectar genoma bacteriano en el líquido cefalorraquídeo; actualmente se etiquetan como meningitis asépticas aquellas en las que el cultivo de líquido cefalorraquídeo es negativo y cuya tinción de Gram es negativa. Pese a que el pronóstico y evolución en rasgos generales de las meningitis tras anestesia y analgesia espinal es bueno, en comparación con las meningitis adquiridas en la comunidad, por la escasa virulencia de las bacterias implicadas (Estreptococo salivarius

  20. [Multimodal pain therapy].

    Böger, A


    Chronic pain has both high prevalence and a significant economic impact in Germany. The most common chronic pain types are low back pain and headache. On the one hand, the management of chronic pain patients is incomplete, yet it is often overtreated in orthopaedic surgical settings with interventional procedures. The reason for this is the structure of outpatient management and the way it is paid for in Germany. Pain management of patients with private insurance cover is no better because of "doctor shopping". Medical guidelines could be of some help in improving the situation, but they are widely unknown, and have still to demonstrate whether they have any impact on GP treatment pathways. The "gold standard" multimodal pain therapy shows significant improvement in many studies compared to monomodal therapy regimes and interventional regimes, but is too rarely recommended by the patients' physicians, whether GPs or specialists. Because of the huge number of institutions nowadays that, for the sake of form, offer such multimodal therapies, these need to be differentiated in terms of their structural and process quality. A first step is the "k edoq" project. It is essential to improve knowledge of the principles of modern pain management. This includes better networking and communication between doctors, physiotherapists and psychologists, and at the grassroots level, providing the public with more detailed and better information. PMID:25000627


    Muhammad Ramli Ahmad


    Full Text Available Objective: To investigate the effect of combination epidural bupivacaine and intravenous parecoxib analgesia on immune response in patients who underwent open reduction and internal fixation of the lower limb under epidural anesthesia. Methods: This research was conducted using the randomized, placebo-controlled double blind trial method on 52 patients who were randomly divided into 2 groups: the Parecoxib group which received 40 mg intravenous parecoxib for 30 minutes before incision and the control group which received an equal volume of 0.9% normal saline. Both groups received epidural anesthesia and postoperative epidural 0.125% bupivacaine analgesia continously. Venous blood samples were obtained before parecoxib administration, 2 and 24 hours after the surgery. The data were analyzed using Mann Whitney U and independent t tests (p<0.05. Results: There was a significant difference between the two groups (p<0.05 in IL-1β, IL-6, IL-10 levels and proinflammatory to anti-inflammatory ratio, 2 hours after surgery. Conclusions: Multimodal analgesic combination of 40 mg IV parecoxib and 0.125% bupivacaine epidural analgesia have the effect to alter and stabilize the systemic immune response.

  2. Organización y actividades preventivas en el sector del transporte de mercancías por carretera

    Elena Ordaz Castillo


    Full Text Available Objetivos: Identificar los recursos y actividades preventivas más prevalentes en el sector del transporte de mercancías por carretera y los hechos diferenciales con el resto de la población trabajadora española. Metodología: Estudio descriptivo de los datos de la Encuesta de Salud y Condiciones de Trabajo del sector del transporte y estudio comparativo con el resto de la población trabajadora a través de la V-Encuesta Nacional de Condiciones de Trabajo. Para el análisis estadístico se ha aplicado el ji cuadrado y la t-student. Resultados: El 77% de las empresas de este sector tienen menos de 50 trabajadores. El 41% de los conductores señala que en su empresa no existe Delegado de Prevención y un 25% no dispone de ningún Recurso Preventivo. Destaca el alto desconocimiento existente entre los conductores de los recursos preventivos en su empresa (34,3%. La modalidad preventiva más frecuentemente instaurada en el sector es la asunción de la prevención por parte del empresario (13,6% a diferencia del resto de sectores donde predomina el SP. Ajeno (43%. Conclusiones: Predominio de la pequeña empresa en el Sector del transporte asociado a un escaso desarrollo del tejido preventivo en comparación con la población de referencia. Ambas características pueden ser determinantes de la menor actividad preventiva, más baja que la observada en la población de referencia. El acceso a actividades preventivas entre los conductores se relaciona con una mejor salud percibida.Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T

  3. Analgesia invasiva domiciliaria en el manejo del dolor postoperatorio en cirugía mayor ambulatoria mediante bombas elastoméricas intravenosas Home invasive analgesia in the management of postoperative pain alter outpatient major surgery using intravenous elastomeric pumps

    R. Rodríguez de la Torre


    Full Text Available Introducción: el dolor postoperatorio moderado-severo sigue siendo un problema en cirugía ambulatoria, ya que provoca problemas de flujo de pacientes, retrasando el alta de los pacientes, siendo uno de los principales motivos de reingreso en los hospitales, y por tanto un importante indicador de calidad de estas Unidades. El empleo de técnicas analgésicas invasivas domiciliarias, en todos sus regímenes, puede controlar el dolor postoperatorio en estas intervenciones y permitir incluirlas en los programas de cirugía ambulatoria. Objetivos: el objetivo de nuestro estudio es valorar la viabilidad y la seguridad de la utilización de bombas de perfusión continua elastoméricas para la administración de analgesia endovenosa continua domiciliaria, a la vez que valorar la eficacia analgésica y el grado de satisfacción de los pacientes intervenidos en régimen ambulatorio. Material y métodos: estudio retrospectivo de 463 pacientes. Una vez intervenidos bajo estrategia de analgesia multimodal, se les coloca dos tipos diferentes de bombas elastoméricas endovenosas (elastómero de dexketoprofeno o de metamizol. La intensidad del dolor, para evaluar la necesidad de analgesia de rescate, se cuantifica con la escala visual analógica o con la escala verbal simple. En el domicilio (24 horas tras la cirugía, la Unidad de Atención Domiciliaria revisa los efectos secundarios, alteraciones del sueño, intensidad del dolor, necesidad de analgesia de rescate y grado de satisfacción. Resultados: un 69% de los pacientes presentaron dolor de carácter leve o ausencia de dolor tras la intervención y únicamente 16 de los 463 pacientes presentaron dolor de carácter severo. El 27% de los pacientes necesitaron analgesia de rescate y un 9% de los pacientes presentaron efectos secundarios atribuibles a los fármacos analgésicos (4% vómitos, 2% mareos, 2,5% somnolencia y 0,5% insomnio. Ningún paciente tuvo que ser reingresado después del alta. Un 83% de

  4. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    Reuben, S S; Steinberg, R B


    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  5. Cycling in multimodal transport behaviours

    Olafsson, Anton Stahl; Nielsen, Thomas Sick; Carstensen, Trine Agervig


    explores how cycling forms part of multimodal transport behaviour based on survey data on transport modes and travel purposes and the weekly frequency of out-of-home activities and travel mode use in a representative sample of adult Danes (n = 1957). The following five distinct multimodal travel segments...... or 'modality styles' are identified: 'education transport'; 'public-based transport'; 'limited transport'; 'bicycle-based transport'; and 'car-based transport'. Travel behaviour is predominantly multimodal with few unimodal car-drivers being identified. Substantial cycling takes place in all modality...... urban settings and small towns. Thus, the way in which travel modes relate to the urban environment and variations in modality styles must serve as the starting point for policies aiming to fulfil the potential of multimodal transport behaviour and promote cycling....

  6. Change in Child Multimodal Counseling.

    Keat, Donald B., II


    Examines some of the effective ingredients of change in multimodal counseling with children: personal relationships; emotions; guidance of actions, behaviors, and consequences; imagery; health; learning; and need to know. (ABL)

  7. Efficacy of the Bilateral Ilioinguinal-Iliohypogastric Block with Intrathecal Morphine for Postoperative Cesarean Delivery Analgesia

    Manuel C. Vallejo


    Full Text Available The ilioinguinal-iliohypogastric (IIIH block is frequently used as multimodal analgesia for lower abdominal surgeries. The aim of this study is to compare the efficacy of IIIH block using ultrasound visualization for reducing postoperative pain after caesarean delivery (CD in patients receiving intrathecal morphine (ITM under spinal anesthesia. Participants were randomly assigned to 1 of 3 treatment groups for the bilateral IIIH block: Group A = 10 mL of 0.5% bupivacaine, Group B = 10 mL of 0.5% bupivacaine on one side and 10 mL of a normal saline (NSS placebo block on the opposite side, and Group C = 10 mL of NSS placebo per side. Pain and nausea scores, treatment for pain and nausea, and patient satisfaction were recorded for 48 hours after CD. No differences were noted with respect to pain scores or treatment for pain over the 48 hours. There were no differences to the presence of nausea (P=0.64, treatment for nausea (P=0.21, pruritus (P=0.39, emesis (P=0.35, or patient satisfaction (P=0.29. There were no differences in pain and nausea scores over the measured time periods (MANOVA, P>0.05. In parturients receiving ITM for elective CD, IIIH block offers no additional postoperative benefit for up to 48 hours.

  8. Sedação e analgesia em terapia intensiva Sedación y analgesia en terapia intensiva Sedation and analgesia in intensive care

    Fábio Ely Martins Benseñor


    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ansiedade e a dor podem causar maior desconforto e risco aumentado de complicações no pós-operatório de pacientes cirúrgicos, prolongando inclusive seu tempo de internação. O objetivo deste estudo foi revisar os conceitos de sedação e analgesia em terapia intensiva, atualizando os conhecimentos e permitindo a revisão das informações disponíveis na literatura, assim como os consensos já publicados. CONTEÚDO: Apresentamos separadamente a sedação e analgesia, revisando cada grupo de fármacos disponível na prática clínica, suas características principais bem como seus efeitos colaterais mais importantes. Acrescentamos alguns protocolos utilizados em nossa UTI para analgesia e sedação, assim como as conclusões do último consenso do Colégio Americano de Medicina Intensiva e da Sociedade Americana de Terapia Intensiva. CONCLUSÕES: Apesar do grande arsenal terapêutico disponível na prática clínica, nota-se um grande desconhecimento das principais características dos fármacos utilizados para sedação e analgesia em terapia intensiva. Os consensos realizados tentam difundir as qualidades e efeitos colaterais dos fármacos mais utilizados, normatizando seu uso, tornando a analgesia e sedação realizadas nas UTI, procedimentos que beneficiem e recuperem mais rapidamente os pacientes.JUSTIFICATIVA Y OBJETIVOS: La ansiedad y el dolor pueden causar grande falta de comodidad y riesgo aumentado de complicaciones en el pos-operatorio de pacientes quirúrgicos, prolongando también su tiempo de internación. El objetivo de este estudio fue revisar los conceptos de sedación y analgesia en terapia intensiva, actualizando los conocimientos y permitiendo la revisión de las informaciones disponibles en la literatura, como también los consensos ya publicados. CONTENIDO: Presentamos separadamente la sedación y analgesia, revisando cada grupo de fármacos disponibles en la práctica clínica, sus

  9. Multimodal texts in kindergarten rooms

    Granly, Astrid; Maagerø, Eva


    This article provides an overview of the results of our project “The Kindergarten Room: A Multimodal Pedagogical Text”. Our major initiative was to investigate what the multimodal texts in kindergarten represent and the extent to which they reflect and provide attributions to the children’s activities. In addition, we wanted to investigate whether kindergarten walls and floors can be called ‘pedagogical texts’, and the extent to which texts on walls and floors establish a particular text cult...

  10. Potentiation of morphine analgesia by subanesthetic doses of pentobarbital.

    Pontani, R B; Vadlamani, N L; Misra, A L


    Pentobarbital pretreatment reportedly either inhibits, enhances or has no effect on morphine analgesia. The effect of subanesthetic doses of sodium pentobarbital (8-12 mg kg-1, SC) delivered via a delivery system on analgesia of morphine (5 mg kg-1, SC or 1 mg kg-1, IV) acutely administered 45 min after the sodium pentobarbital pellet implantation was assessed using the warm water (55 degrees C)-induced tail-withdrawal reflex in male Wistar rats. Significant potentiation of morphine analgesia was observed in sodium pentobarbital as compared to the placebo-pelleted animals. Pharmacokinetic or dispositional factors were not involved in this potentiation, which was possibly due to the activation of the descending inhibitory control pathways of nociceptive spinal tail-withdrawal reflex by a combined interaction of two drugs at spinal and supraspinal sites of action, that mediate opiate antinociception. PMID:3991755

  11. The neuroanatomy of sexual dimorphism in opioid analgesia.

    Loyd, Dayna R; Murphy, Anne Z


    The influence of sex has been neglected in clinical studies on pain and analgesia, with the vast majority of research conducted exclusively in males. However, both preclinical and clinical studies indicate that males and females differ in both the anatomical and physiological composition of central nervous system circuits that are involved in pain processing and analgesia. These differences influence not only the response to noxious stimuli, but also the ability of pharmacological agents to modify this response. Morphine is the most widely prescribed opiate for the alleviation of persistent pain in the clinic; however, it is becoming increasingly clear that morphine is less potent in women compared to men. This review highlights recent research identifying neuroanatomical and physiological dimorphisms underlying sex differences in pain and opioid analgesia, focusing on the endogenous descending pain modulatory circuit. PMID:24731947

  12. Balanced analgesia: what is it and what are its advantages in postoperative pain?

    Kehlet, H; Werner, M; Perkins, F


    The concept of balanced analgesia was introduced to improve analgesic efficacy and reduce adverse effects. A large amount of clinical data has documented improved analgesia by combining different analgesics, but data on reducing adverse effects are inconclusive. Balanced analgesia should be used ...


    V. A. Titova


    Full Text Available Multmodal programs are the perspective trend in different malignant tumors treatment but increasing risk of combined complications may influence negatively on the results. Ozone therapy and low-intense laser therapy are perspective methods for complication treatment and prevention as they show their own antibacterial, analgesia and detoxing activity in experiment.To form the algorhythm and to evaluate the results of intravenous and local ozone applications plus low-intense laser (LILT therapeutic complex used in treatment and prevention of malignant tumors multimodal treatment complications.

  14. Does epidural clonidine improve postoperative analgesia in major vascular surgery?

    Jelena Vuković


    Full Text Available Aim To determine the quality and duration of the analgesic and haemodynamic effects of clonidine when used as an additional analgesic for postoperative epidural analgesia in major vascularsurgery. Methods The prospective, single-blinded study involved 60 patients randomised into three groups (20 patients each: Group BM—bupivacaine 0.125% and morphine 0.1 mg/ml; Group BC—bupivacaine 0.125% and clonidine 5 μg/ml; Group MC—morphine 0.1 mg/ml and clonidine 5 μg/ml continuously infused at 5 ml/h. The quality and duration of the analgesia measured by the Visual Analogue Scale (VAS at rest and on movement, additional analgesia requirements, sedation scores, haemodynamic parameters and side effects(respiratory depression, motor block, toxic effects, nausea and pruritus were recorded. Results The average VAS scores at rest and on movement were significantly lower in Group MC at two, six and 24 hours following the start of epidural infusion (P<0.05. The duration of the analgesic effect after finishing the epidural infusion was significantly longer in Group MC (P<0.05. Patients from Group MC were intubated longer. Additional analgesia consumption, sedation scoresand haemodynamic profiles were similar in all three groups. Prurituswas more frequent in morphine groups (P<0.05, but other sideeffects were similar in all three groups.Conclusion Under study conditions, clonidine added to morphine,not 0.125% bupivacaine, provided significantly better pain scoresat two, six and 24 hours following the start of epidural infusionand the longest-lasting analgesia following the discontinuationof epidural infusion. However, patients from the Group MC weremechanically ventilated longer than patients from other two groups.Continuous monitoring of the patient is necessary after theadministration of clonidine for epidural analgesia.

  15. DHEA administration modulates stress-induced analgesia in rats.

    Cecconello, Ana Lúcia; Torres, Iraci L S; Oliveira, Carla; Zanini, Priscila; Niches, Gabriela; Ribeiro, Maria Flávia Marques


    An important aspect of adaptive stress response is the pain response suppression that occurs during or following stress exposure, which is often referred to as acute stress-induced analgesia. Dehydroepiandrosterone (DHEA) participates in the modulation of adaptive stress response, changing the HPA axis activity. The effect of DHEA on the HPA axis activity is dependent on the state and uses the same systems that participate in the regulation of acute stress-induced analgesia. The impact of DHEA on nociception has been studied; however, the effect of DHEA on stress-induced analgesia is not known. Thus, the aim of the present study was to evaluate the effect of DHEA on stress-induced analgesia and determine the best time for hormone administration in relation to exposure to stressor stimulus. The animals were stressed by restraint for 1h in a single exposure and received treatment with DHEA by a single injection before the stress or a single injection after the stress. Nociception was assessed with a tail-flick apparatus. Serum corticosterone levels were measured. DHEA administered before exposure to stress prolonged the acute stress-induced analgesia. This effect was not observed when the DHEA was administered after the stress. DHEA treatment in non-stressed rats did not alter the nociceptive threshold, suggesting that the DHEA effect on nociception is state-dependent. The injection of DHEA had the same effect as exposure to acute stress, with both increasing the levels of corticosterone. In conclusion, acute treatment with DHEA mimics the response to acute stress indexed by an increase in activity of the HPA axis. The treatment with DHEA before stress exposure may facilitate adaptive stress response, prolonging acute stress-induced analgesia, which may be a therapeutic strategy of interest to clinics. PMID:26852948

  16. Analgesia postoperatoria con tramadol epidural tras histerectomía abdominal Epidural postoperative analgesia with tramadol after abdominal hysterectomy

    E. González-Pérez


    Full Text Available Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular cada 6 h. Grupo III: recibió 100 mg de tramadol por vía intramuscular cada 6 h. Se evaluó el comportamiento de la presión arterial media y la frecuencia cardíaca. Evaluamos la intensidad del dolor por medio de una Escala Visual Analógica. Fue utilizado metamizol sódico, 2 g endovenoso, como analgesia de rescate. Resultados: Se presentaron variaciones significativas de la frecuencia cardíaca y presión arterial media en el grupo I (P0,05, por lo que sólo 2 pacientes requirieron analgesia de rescate, mientras que el grupo II mostró las mayores variaciones (PIntroduction: Postoperative pain is a special type of acute pain whose inadequate control leads to abnormal reactions. Objectives: To evaluate the utility of tramadol by the epidural route in the postoperative analgesia of patients undergoing abdominal hysterectomy. Material and method: 90 patients studied who conformed three groups: Group I: received 100 mg of epidural tramadol every 6 h. Group II: received 1.2 g of intramuscular metamizol every 6 h. Group III: received 100 mg of intramuscular tramadol every 6 h. Blood pressure and heart rate were measured. Pain intensity was evaluated by a visual analogical scale. Metamizol 2 g was used as rescue analgesia. Results: Significant variations of heart rate and mean blood pressure were found in group I (p < 0.05 whereas in group II and III they were very significant (p < 0.01. The intensity of postoperative pain reached lower values in group I

  17. [Multimodal iatrogenic apathy].

    Oliveira-Souza, R D; Figueiredo, W M


    The present paper reports on five patients who developed apathy as a peculiar side effect of antidepressants. Their behavioral and psychopathological changes were primarily due to the near-absence of emotional experience, a key characteristic that distinguishes apathy from avolition and abulia. The emergence of apathy in the course of an antidepressant treatment should raise the suspicion of an adverse effect of the drug and lead to its prompt withdrawal. A sample of the relevant clinical evidence favoring the distinction of apathy confined to a single sensory domain ("unimodal apathy") from apathy confined to more than one sensory realm ("multimodal apathy") is reviewed. From a pathophysiological standpoint, it would appear that neural nets centered in the amygdala-temporo polar cortex are critical for the integration of sensory perceptions and mental imagery with appropriate emotional tone and quality as well as with their accompanying somatic markers, as they receive afferents from the major projection systems of the prosencephalon and lie in nodes strategic to modify the ongoing activity of multiple parallel brain systems. The fact that one common symptom can be produced by such a heterogeneous family of substances points to a shared neurochemical mechanism of action. At present, discrete cerebral serotoninergic circuits would appear to be suitable candidates for such a role. Cases as these may be critical for the understanding of the cerebral organization of emotions in man, lending support to the notion that distinct neurochemical systems mediate discrete psychopathological symptoms. PMID:8984978

  18. La sinergia farmacológica aplicada a la analgesia: revisión de la combinación de ibuprofeno con codeína Pharmacological synergy applied to analgesia: review of the combination of ibuprofen with codeine

    J.R. González-Escalada


    Full Text Available La analgesia multimodal que participa actualmente en todos los protocolos de analgesia postoperatoria también se utiliza por los especialistas en dolor crónico que manejan la combinación de fármacos como una rutina para optimizar la eficacia de la analgesia; la combinación de fármacos es una práctica bien conocida y muy extendida, gracias a su demostrada rentabilidad terapéutica, y habitualmente se utiliza tanto en anestesia como en analgesia. El concepto del balance adecuado entre efectividad y seguridad es primordial, y aunque la calidad del tratamiento aplicado se mide según el alivio conseguido, el confort se evalúa teniendo en cuenta la combinación entre eficacia analgésica y la ausencia o mínima presencia de efectos secundarios, siendo primordial en el tratamiento del paciente con dolor. En este sentido, parece claro que la búsqueda de las dosis mínimas eficaces de cada fármaco es una premisa necesaria para plantear la combinación de dosis idónea. La búsqueda de los fármacos que deben componer una combinación y las dosis a emplear debe ser fruto de la investigación, pero debe ser corroborada por la experiencia clínica, la opinión de los expertos y las evidencias publicadas. En este trabajo, se realiza una extensa revisión de la experiencia clínica existente con la combinación de ibuprofeno con codeína, haciendo un análisis de los antecedentes históricos que llevaron a su uso, los trabajos que permitieron demostrar su sinergia y compatibilidad farmacocinética y los trabajos pioneros de investigación clínica que permitieron concluir que la dosis fija idónea de esta combinación es la mezcla de 400 mg de ibuprofeno con 30 mg de codeína. Es difícil sacar conclusiones acerca de la efectividad analgésica de los diferentes antiinflamatorios no esteroideos, pero no cabe duda que según los datos acumulados hasta la actualidad, el ibuprofeno se sitúa entre los más efectivos y es una buena opción para

  19. Analgesia and sedation for children undergoing burn wound care.

    Bayat, Ahmad; Ramaiah, Ramesh; Bhananker, Sanjay M


    Standard care of burn wounds consists of cleaning and debridement (removing devitalized tissue), followed by daily dressing changes. Children with burns undergo multiple, painful and anxiety-provoking procedures during wound care and rehabilitation. The goal of procedural sedation is safe and efficacious management of pain and emotional distress, requiring a careful and systematic approach. Achieving the best results needs understanding of the mechanisms of pain and the physiologic changes in burn patients, frequent evaluation and assessment of pain and anxiety, and administration of suitable pharmacological and nonpharmacological therapies. Pharmacological therapies provide the backbone of analgesia and sedation for procedural pain management. Opioids provide excellent pain control, but they must be administered judiciously due to their side effects. Sedative drugs, such as benzodiazepines and propofol, provide excellent sedation, but they must not be used as a substitute for analgesic drugs. Ketamine is increasingly used for analgesia and sedation in children as a single agent or an adjuvant. Nonpharmacological therapies such as virtual reality, relaxation, cartoon viewing, music, massage and hypnosis are necessary components of procedural sedation and analgesia for children. These can be combined with pharmacological techniques and are used to limit the use of drugs (and hence side effects), as well as to improve patient participation and satisfaction. In this article, we review the pathophysiologic changes associated with major thermal injury in children, the options available for sedation and analgesia for wound care procedures in these children and our institutional guidelines for procedural sedation. PMID:20977331

  20. Liposomal extended-release bupivacaine for postsurgical analgesia

    Lambrechts M


    Full Text Available Mark Lambrechts,1,2 Michael J O’Brien,2 Felix H Savoie,2 Zongbing You1–31Department of Structural and Cellular Biology, 2Department of Orthopaedic Surgery and Tulane Institute of Sports Medicine, 3Tulane Cancer Center, Louisiana Cancer Research Consortium, Tulane Center for Aging, Tulane Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USAAbstract: When physicians consider which analgesia to use postsurgery, the primary goal is to relieve pain with minimal adverse side effects. Bupivacaine, a commonly used analgesic, has been formulated into an aqueous suspension of multivesicular liposomes that provide long-lasting analgesia for up to 72 hours, while avoiding the adverse side effects of opioids. The increased efficacy of liposomal extended-release bupivacaine, compared to bupivacaine hydrochloride, has promoted its usage in a variety of surgeries including hemorrhoidectomy, bunionectomy, inguinal hernia repair, total knee arthroplasty, and augmentation mammoplasty. However, like other bupivacaine formulations, the liposomal extended-release bupivacaine does have some side effects. In this brief review, we provide an update of the current knowledge in the use of bupivacaine for postsurgical analgesia. Keywords: bupivacaine, liposome, analgesia, side effects, efficacy, patient satisfaction

  1. Epidural morphine analgesia in Guillain Barré syndrome.

    Genis, D; Busquets, C; Manubens, E; Dávalos, A; Baró, J; Oterino, A


    Severe pain is a frequent symptom in the Guillain Barré syndrome and can be intense, long lasting and with no response to the usual analgesics, including parenteral opiates. Epidural analgesia using morphine chloride in low doses has satisfactorily relieved pain in this disease in nine patients.

  2. Effect of irradiation on analgesia induced by morphine and endorphin

    Kim, Jin Kyu; Lee, Byoung Hun; Hyun, Soung Hee; Chung, Ki Myung [KAERI, Daejeon (Korea, Republic of)


    Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a {sup 60}Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms.

  3. Effect of irradiation on analgesia induced by morphine and endorphin

    Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a 60Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms

  4. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA? Should epidural analgesia still be a routine technique in pain units?

    F. Caba


    .Epidural analgesia has become a routine process in the peri-operative management of surgical patients which has been extended from the operating rooms and high dependency units to hospital wards. The irruption into this new scenario has improved post-surgical analgesia with acceptable safety margins, and has secured a predominant place in the analgesia guidelines of Acute Pain Units (APU. Epidural analgesia with local anaesthetics and opioids, compared to systemic with opioids, has historically been more effective, with a decrease in complications due to the reduction in surgical stress and the improved cardiorespiratory function. However, as well as these these advantages, epidural analgesia also has some disadvantages such as lowering of blood pressure or urinary retention, along with potentially serious ones arising from neurological damage caused by epidural haematoma, infection or direct injury of the nerve tissue. Although its advantages have been consistent and solid, it does seem to be the case today. The advances made in minimally invasive surgery, with earlier hospital discharge, together with multimodal strategies, are leading to the re-establishment of the use of techniques such as epidural and a re-evaluation of its indications. The latest evidence leads us to believe that epidural analgesia has reached its limit in the treatment of post-surgical pain and will begin to lose ground with the introduction of equally effective techniques, with less complications and secondary effects. This will be a slow process in which it must be assured that the alternative analgesics really give better results as regards efficacy, safety, tolerability and quality of recovery from the perspective of the patient.

  5. A Multimodal Approach to Post-Operative Pain Relief in Children Undergoing Ambulatory Eye Surgery

    V V Jaichandran


    Full Text Available This study was carried to assess the efficacy of multimodal analgesia using ketorolac and fentanyl, for post-operative pain relief in children undergoing ambulatory eye surgery. Total of 161 children, aged 1 to 5 years, were randomly stratified to three different analgesic regimens: Group A Ketorolac 0.75 -1 I.M. , Group B Fentanyl 0.75 µ -1 I.V. and Group C Ketorolac -1 I.M. and Fentanyl 0.50µ -1 I.V. Ketorolac I.M. was given 45 minutes before extubation and fentanyl I.V. was given soon after extubation in the respective groups. Post-operative pain was assessed in a double blinded manner using Children′s Hospital of Eastern Onatario Pain Scale (CHEOPS scoring system and by recording the heart rate at 10, 30 and 60 minutes. If the score was above 8, the child was left with the parents. In case the score did not improve and persisted to be greater than 8, fentanyl 0.50µ -1 I.V. was given as the rescue analgesia. The incidence of nausea, vomiting, sleep disturbances or any other complaints were recorded by a staff nurse 24 hours post operatively. Mean CHEOPS score at 10, 30 and 60 minutes and mean heart rate at 10 and 30 minutes were significantly higher for Group A compared with Group C. Mean pain score emerged significantly higher for Group B compared with Group C at 30 and 60 minutes, (P< 0.01. Rescue analgesia required was significantly higher in Group A compared to Groups B and C, (P< 0.0001. Post-operatively, significant incidence of drowsiness was reported in children in Group B compared to Groups A and C, (P< 0.01. A multimodal approach using both ketorolac and fentanyl at low doses produce effective and safe analgesia in children undergoing ambula-tory eye surgery.

  6. Multimodal Transport Operator Liability Insurance Model

    Zelenika, Ratko; Lotrič, Tomaž; Bužan, Ervin


    Multimodal transportation means transporting goods from a pickup point, where the operator receives the goods, all the way to the delivery location, using at least two different means of transportation, covered under the same multimodal transport contract and by only one document, regardless of the number or type of transportation vehicles used. The key factor to the optimal operation of multimodal transportation is the multimodal transport operator. It is up to this individual to compensate ...

  7. Poetry Teaching and Multimodality: Theory into Practice

    Daniel Xerri


    This article discusses the theoretical concepts underpinning a multimodal approach to poetry teaching and considers a number of ways in which this can be adopted in practice. It discusses what is entailed by the concept of multimodality and examines the claims made about the benefits of employing a multimodal approach. It reviews the literature on multimodality and examines how teachers may blend a variety of techniques and resources in order not just to engage their students with poetry but ...

  8. Multimodal Aspects of Corporate Social Responsibility Communication

    Carmen Daniela Maier


    This article addresses how the multimodal persuasive strategies of corporate social responsibility communication can highlight a company’s commitment to gender empowerment and environmental protection while advertising simultaneously its products. Drawing on an interdisciplinary methodological framework related to CSR communication, multimodal discourse analysis and gender theory, the article proposes a multimodal analysis model through which it is possible to map and explain the multimodal p...

  9. Genetic Algorithm Application for Multimodal Transportation Networks

    Xiaoli Wang; Bing Wang


    To enhance the efficiency and feasibility in decision-making for multimodal transportation operator, supplying chain management are creating greater demand for multimodal transportation system. So, the problem of an improved model with transportation mode and routes in multimodal transportation networks is established. Aiming at minimizing the overall transport cost, a programming model of multimodal transportation constraint is established. Besides the transportation economies of scale...

  10. A Cuckoo Search Algorithm for Multimodal Optimization

    Erik Cuevas; Adolfo Reyna-Orta


    Interest in multimodal optimization is expanding rapidly, since many practical engineering problems demand the localization of multiple optima within a search space. On the other hand, the cuckoo search (CS) algorithm is a simple and effective global optimization algorithm which can not be directly applied to solve multimodal optimization problems. This paper proposes a new multimodal optimization algorithm called the multimodal cuckoo search (MCS). Under MCS, the original CS is enhanced with...

  11. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    Fanning, Rebecca A


    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  12. Multimodal Friction Ignition Tester

    Davis, Eddie; Howard, Bill; Herald, Stephen


    The multimodal friction ignition tester (MFIT) is a testbed for experiments on the thermal and mechanical effects of friction on material specimens in pressurized, oxygen-rich atmospheres. In simplest terms, a test involves recording sensory data while rubbing two specimens against each other at a controlled normal force, with either a random stroke or a sinusoidal stroke having controlled amplitude and frequency. The term multimodal in the full name of the apparatus refers to a capability for imposing any combination of widely ranging values of the atmospheric pressure, atmospheric oxygen content, stroke length, stroke frequency, and normal force. The MFIT was designed especially for studying the tendency toward heating and combustion of nonmetallic composite materials and the fretting of metals subjected to dynamic (vibrational) friction forces in the presence of liquid oxygen or pressurized gaseous oxygen test conditions approximating conditions expected to be encountered in proposed composite material oxygen tanks aboard aircraft and spacecraft in flight. The MFIT includes a stainless-steel pressure vessel capable of retaining the required test atmosphere. Mounted atop the vessel is a pneumatic cylinder containing a piston for exerting the specified normal force between the two specimens. Through a shaft seal, the piston shaft extends downward into the vessel. One of the specimens is mounted on a block, denoted the pressure block, at the lower end of the piston shaft. This specimen is pressed down against the other specimen, which is mounted in a recess in another block, denoted the slip block, that can be moved horizontally but not vertically. The slip block is driven in reciprocating horizontal motion by an electrodynamic vibration exciter outside the pressure vessel. The armature of the electrodynamic exciter is connected to the slip block via a horizontal shaft that extends into the pressure vessel via a second shaft seal. The reciprocating horizontal




    Full Text Available BACKGROUND: Clonidine is an α 2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 μg and 75 μg on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS : A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group received 3ml hyperbaric bupivacaine, Group II (n=25 3ml hyperbar ic bupivacaine + 37.5 μg clonidine and Group III (n=25 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD dura tion of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05. It shows that 37.5  g & 75  g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by abo ut 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 μg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5  g & 75  g as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects

  14. Effect of epidural analgesia on labor and its outcomes

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

  15. Multimodal Neuroelectric Interface Development

    Trejo, Leonard J.; Wheeler, Kevin R.; Jorgensen, Charles C.; Totah, Joseph (Technical Monitor)


    This project aims to improve performance of NASA missions by developing multimodal neuroelectric technologies for augmented human-system interaction. Neuroelectric technologies will add completely new modes of interaction that operate in parallel with keyboards, speech, or other manual controls, thereby increasing the bandwidth of human-system interaction. We recently demonstrated the feasibility of real-time electromyographic (EMG) pattern recognition for a direct neuroelectric human-computer interface. We recorded EMG signals from an elastic sleeve with dry electrodes, while a human subject performed a range of discrete gestures. A machine-teaming algorithm was trained to recognize the EMG patterns associated with the gestures and map them to control signals. Successful applications now include piloting two Class 4 aircraft simulations (F-15 and 757) and entering data with a "virtual" numeric keyboard. Current research focuses on on-line adaptation of EMG sensing and processing and recognition of continuous gestures. We are also extending this on-line pattern recognition methodology to electroencephalographic (EEG) signals. This will allow us to bypass muscle activity and draw control signals directly from the human brain. Our system can reliably detect P-rhythm (a periodic EEG signal from motor cortex in the 10 Hz range) with a lightweight headset containing saline-soaked sponge electrodes. The data show that EEG p-rhythm can be modulated by real and imaginary motions. Current research focuses on using biofeedback to train of human subjects to modulate EEG rhythms on demand, and to examine interactions of EEG-based control with EMG-based and manual control. Viewgraphs on these neuroelectric technologies are also included.

  16. Multimodal integration of time.

    Bausenhart, Karin M; de la Rosa, Maria Dolores; Ulrich, Rolf


    Recent studies suggest that the accuracy of duration discrimination for visually presented intervals is strongly impaired by concurrently presented auditory intervals of different duration, but not vice versa. Because these studies rely mostly on accuracy measures, it remains unclear whether this impairment results from changes in perceived duration or rather from a decrease in perceptual sensitivity. We therefore assessed complete psychometric functions in a duration discrimination task to disentangle effects on perceived duration and sensitivity. Specifically, participants compared two empty intervals marked by either visual or auditory pulses. These pulses were either presented unimodally, or accompanied by task-irrelevant pulses in the respective other modality, which defined conflicting intervals of identical, shorter, or longer duration. Participants were instructed to base their temporal judgments solely on the task-relevant modality. Despite this instruction, perceived duration was clearly biased toward the duration of the intervals marked in the task-irrelevant modality. This was not only found for the discrimination of visual intervals, but also, to a lesser extent, for the discrimination of auditory intervals. Discrimination sensitivity, however, was similar between all multimodal conditions, and only improved compared to the presentation of unimodal visual intervals. In a second experiment, evidence for multisensory integration was even found when the task-irrelevant modality did not contain any duration information, thus excluding noncompliant attention allocation as a basis of our results. Our results thus suggest that audiovisual integration of temporally discrepant signals does not impair discrimination sensitivity but rather alters perceived duration, presumably by means of a temporal ventriloquism effect. PMID:24351985

  17. A review about multimodal traffic simulation techniques



    Full Text Available One of the current challenges in urban planning concerns the urban transportation involving multi-mode transportation. One of the ways to evaluate different situations in order to make decisions of how, when and where to invest is using multimodal traffic simulation. This paper presents a review about multimodal traffic simulation, identifying the state of art and directions for future work.

  18. Multimodal Aspects of Corporate Social Responsibility Communication

    Carmen Daniela Maier


    Full Text Available This article addresses how the multimodal persuasive strategies of corporate social responsibility communication can highlight a company’s commitment to gender empowerment and environmental protection while advertising simultaneously its products. Drawing on an interdisciplinary methodological framework related to CSR communication, multimodal discourse analysis and gender theory, the article proposes a multimodal analysis model through which it is possible to map and explain the multimodal persuasive strategies employed by Coca-Cola company in their community-related films. By examining the semiotic modes’ interconnectivity and functional differentiation, this analytical endeavour expands the existing research work as the usual textual focus is extended to a multimodal one.

  19. The Multimodal Possibilities of Online Instructions

    Kampf, Constance


    The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi-modal analy......The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi...

  20. Multimodality and Multiresolution Image Fusion

    Zeeuw, P.M. de; Pauwels, E.J.; Han, J.; Csurka, G.; Braz, J.


    Standard multiresolution image fusion of multimodal images may yield an output image with artifacts due to the occurrence of opposite contrast in the input images. Equal but opposite contrast leads to noisy patches, instable with respect to slight changes in the input images. Unequal and opposite co

  1. Brief Psychotherapy: The Multimodal Model.

    Lazarus, Arnold A.


    Outlines tenets of multimodal therapy (MMT) and argues for its cost-effective yet comprehensive value as a brief psychotherapy model. Describes MMT as an integrated, seven-modality model of personality and provides clinical examples of its use. Argues that MMT approach will be an important future alternative to more expensive, time-consuming, and…

  2. Multi-Modality Phantom Development

    Huber, Jennifer S.; Peng, Qiyu; Moses, William W.


    Multi-modality imaging has an increasing role in the diagnosis and treatment of a large number of diseases, particularly if both functional and anatomical information are acquired and accurately co-registered. Hence, there is a resulting need for multi modality phantoms in order to validate image co-registration and calibrate the imaging systems. We present our PET-ultrasound phantom development, including PET and ultrasound images of a simple prostate phantom. We use agar and gelatin mixed with a radioactive solution. We also present our development of custom multi-modality phantoms that are compatible with PET, transrectal ultrasound (TRUS), MRI and CT imaging. We describe both our selection of tissue mimicking materials and phantom construction procedures. These custom PET-TRUS-CT-MRI prostate phantoms use agargelatin radioactive mixtures with additional contrast agents and preservatives. We show multi-modality images of these custom prostate phantoms, as well as discuss phantom construction alternatives. Although we are currently focused on prostate imaging, this phantom development is applicable to many multi-modality imaging applications.

  3. Stereospecific potentiation of opiate analgesia by cocaine: predominant role of noradrenaline.

    Misra, A L; Pontani, R B; Vadlamani, N L


    Cocaine hydrochloride (50 mg) pellets implanted subcutaneously in male Wistar rats potentiated the analgesia of morphine, levorphanol, methadone and buprenorphine as measured by the tail-withdrawal test. Potentiated opiate analgesia was abolished by naloxone and further enhanced by desipramine and phenoxybenzamine. Yohimbine, alpha-methyl p-tyrosine, haloperidol, zimelidine, methysergide, p-chlorophenylalanine produced no significant effect on potentiated opiate analgesia. Pseudo-cocaine (dextro-cocaine), which is several-fold less potent than cocaine as an inhibitor of noradrenaline and dopamine reuptake in the CNS, had no significant effect on opiate analgesia. Analgesia produced by low doses of baclofen, a GABA agonist, was also not potentiated by cocaine. This study suggests a predominant role for noradrenaline in the stereospecific potentiation of opiate analgesia by cocaine. PMID:3822492

  4. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia

    Joshi, G.P.; Bonnet, F.; Shah, R.;


    evidence is needed to assess the comparative benefits of alternative techniques, guide clinical practice and identify areas requiring further research. METHODS: In this systematic review of randomized trials we evaluated thoracic epidural, paravertebral, intrathecal, intercostal, and interpleural analgesic...... techniques, compared to each other and to systemic opioid analgesia, in adult thoracotomy. Postoperative pain, analgesic use, and complications were analyzed. RESULTS: Continuous paravertebral block was as effective as thoracic epidural analgesia with local anesthetic (LA) but was associated with a reduced...... incidence of hypotension. Paravertebral block reduced the incidence of pulmonary complications compared with systemic analgesia, whereas thoracic epidural analgesia did not. Thoracic epidural analgesia was superior to intrathecal and intercostal techniques, although these were superior to systemic analgesia...

  5. Sensitivity of quantitative sensory models to morphine analgesia in humans

    Olesen AE; Brock C; Sverrisdóttir E; Larsen IM; Drewes AM


    Anne Estrup Olesen,1,2 Christina Brock,1,2 Eva Sverrisdóttir,2 Isabelle Myriam Larsen,1 Asbjørn Mohr Drewes1,3 1Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; 2Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark Introduction: Opioid analgesia can be explored with quantitat...

  6. The impact of patients controlled analgesia undergoing orthopedic surgery

    Aluane Silva Dias; Tathyana Rinaldi; Luciana Gardin Barbosa


    ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA) controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and di...

  7. Pain relief and clinical outcome: from opioids to balanced analgesia

    Kehlet, H


    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  8. Intrapartum analgesia as a condition of human satisfaction at hospital

    Concetta Polizzi


    Full Text Available The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia called the A group, and the control group (women who refused it called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

  9. Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

    Park, Kwang Ok; Lee, Yoon Young


    Background Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and...


    Laura Magdalena Nicolescu


    Full Text Available Epidural anesthesia and analgesia is widely used to manage major abdominal surgery, but its effects in managing patients submitted to esophagoplasty are still debated. The aim of this study was to assess the influence of thoracic epidural anaesthesia on postoperative respiratory function, digestive complications and postoperative stress in patients with esophagoplasty. Twenty-six patients were admitted in a prospective study. The patients were divided into two groups: fourteen were in group A, and received general anaesthesia for esophagoplasty, and twelve were in group B, and received general anaesthesia combined with epidural thoracic anaesthesia and postoperative epidural thoracic analgesia for the same surgery procedure. When compare the two groups, the outcomes were better in group B: the rate of postoperative pneumonia was lowered from 35,7% to 16,7%, the postoperative mecanical ventilation under six hours was increased from 21,43% to 100%, the incidence of adult respiratory detrease syndrome was decreased from 28,5% to 8,3%, the digestive recovery after four days was increased from 57,1% to 75%. The cortizolemia was also lowered at six hours from 52mg% to 23mg%, and at 24 hours, from 22 to 11mg%. Identically, the sanguine lactate at four hours decreased from 6 to 3 mEq%. In conclusion, this study suggest that patients undergoing esophagoplasty will receive substantial benefit from combined general and epidural anesthesia with continuing postoperative epidural analgesia.

  11. Stereotactic core biopsy of an impalpable screen-detected breast lesion using acupuncture-analgesia

    English, R E; Chen, J. H.


    Chinese acupuncture-analgesia is used for pain management during various surgical procedures. Over the past 40 years this approach has been introduced in many countries and has been particularly helpful in the investigation and treatment of patients who are unable to tolerate conventional analgesia. We report here the case of a woman with a 17-year history of myalgic encephalitis who underwent a stereotactic core biopsy of the breast under acupuncture-analgesia. A planning session was needed ...

  12. Study of efficacy, safety and cardiotocographic changes during epidural analgesia with ropivacaine in labour

    Sharma, Jyoti; Gandhi, Mansi U; Bhavsar, Mrugank M


    Background: Epidural analgesia during labour provides effective pain relief along with better maternal and neonatal outcome. Our aim of the study is to check safety and efficacy of Ropivacaine during labour analgesia. We have also compared cardiotocographic changes in labour with versus without epidural analgesia.Material & Methods: 60 Antenatal cases in between 37-41 weeks of pregnancy in active labour were selected for study. They were randomly divided into 2 groups: Study Group (Group-...

  13. Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

    Uma Srivastava


    Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ì of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

  14. Evaluación Inicial de Riesgos Laborales y Planificación de acciones preventivas de un taller mecánico de automóviles

    San-Jaime, Agustín


    El presente Trabajo de Fin de Master (TFM) tiene como objetivo realizar una aplicación práctica de los conocimientos adquiridos en el Master Oficial Universitario en Prevención de Riesgos Laborales de la UNIR durante el curso académico 2011/2012. Los alumnos hemos de elegir entre una de las tres disciplinas preventivas o especialidades técnicas en las que se divide la actividad, y más concretamente aquella por la que no hubiésemos optado durante las Práctica de Empresa desarrolladas previa...


    Álvarez-Ruiz, Laura


    En el presente Trabajo Fin de Máster se desarrolla la Evaluación de Riesgos y Planificación de Actividades Preventivas de una planta de Recuperación de Papel y Cartón. Según las labores que se desarrollan en el centro se identifican tres puestos de trabajo: oficina, producción en planta y mecánico/mantenimiento. Para el análisis de riesgos, y su posterior valoración, se sigue la metodología expuesta por el Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT) en la gu...

  16. Odontología preventiva y comunitaria. 3º curso de Odontología. Cuaderno de prácticas preclínicas

    Lartitegui Sebastián, Mª José


    La realización de las prácticas preclínicas de odontología preventiva y comunitaria tiene como principal objetivo ser un complemento de las enseñanzas teóricas, y situar al alumno en un escenario sanitario de situaciones y problemáticas asistenciales, comparables a las que podrían presentarse en su ejercicio profesional, contribuyendo a capacitarle, por tanto, para la realización de las prácticas clínicas con pacientes. El adecuado desarrollo de las prácticas deberá permitir al alumno adqu...

  17. Conservación preventiva y gestión del mantenimiento edilicio en museos: ¿criterio profesional o sentido común?

    Amor, Mariela C.


    La conservación preventiva en museos es una intervención continua e integral, un conjunto de estrategias de carácter técnico y de gestión que se aplican para prevenir el deterioro y garantizar la conservación material de los bienes culturales. Abarca desde las condiciones medioambientales, hasta las de exposición, almacenaje, mantenimiento, seguridad o manipulación de las piezas. El factor más importante para la preservación de las colecciones del museo es el correcto control de las condicion...

  18. Evolución histórica de la enseñanza de la medicina preventiva en la carrera de medicina en Cuba

    Martínez Calvo, Silvia


    Durante los 200 años que median de 1810-2010, obviamente ha evolucionado el contexto social, económico y político de los cubanos y, en cuanto a la situación de salud, en los últimos 50 años, el cambio ha sido impresionante, al transformarse el panorama epidemiológico nacional –entre otros factores por una consecuente y permanente política de salud. En este trabajo se describe la evolución de la enseñanza de la Medicina Preventiva en ese lapso, como factor contribuyente para la modificación de...

  19. Preventiva samomora pri mladostnikih

    Kotnik, Petra


    Samomor je vzrok številnim smrtim. Zasledimo ga v različnih literaturah, tako strokovnih, kot laičnih. Samomor predstavlja zelo visoko smrtnost v svetu. Zaradi samomora ljudje umirajo, tako kot za ostalimi boleznimi, ki ogrožajo prebivalstvo. Velik problem je samomor med mladimi, ki so občutljiva skupina, ki samomorilne namene kažejo z drugačnimi znaki, kot odrasle in starejše osebe. Tako kot strokovnjaki bi tudi laiki morali poznati vzroke, dejavnike tveganja in nasploh poznati starostne sku...

  20. Continuous verification using multimodal biometrics.

    Sim, Terence; Zhang, Sheng; Janakiraman, Rajkumar; Kumar, Sandeep


    Conventional verification systems, such as those controlling access to a secure room, do not usually require the user to reauthenticate himself for continued access to the protected resource. This may not be sufficient for high-security environments in which the protected resource needs to be continuously monitored for unauthorized use. In such cases, continuous verification is needed. In this paper, we present the theory, architecture, implementation, and performance of a multimodal biometrics verification system that continuously verifies the presence of a logged-in user. Two modalities are currently used--face and fingerprint--but our theory can be readily extended to include more modalities. We show that continuous verification imposes additional requirements on multimodal fusion when compared to conventional verification systems. We also argue that the usual performance metrics of false accept and false reject rates are insufficient yardsticks for continuous verification and propose new metrics against which we benchmark our system. PMID:17299225

  1. Robustness of multimodal processes itineraries

    Bocewicz, G.; Banaszak, Z.; Nielsen, Izabela Ewa


    itineraries for assumed (O-D) trip. Since itinerary planning problem, constitutes a common routing and scheduling decision faced by travelers, hence the main question regards of itinerary replanning and particularly a method aimed at prototyping of mode sequences and paths selections. The declarative model of......This paper concerns multimodal transport systems (MTS) represented by a supernetworks in which several unimodal networks are connected by transfer links and focuses on the scheduling problems encountered in these systems. Assuming unimodal networks are modeled as cyclic lines, i.e. the routes...... multimodal processes driven itinerary planning problem is our main contribution. Illustrative examples providing alternative itineraries in some cases of MTS malfunction are presented....

  2. Multimodal Phantom of Liver Tissue

    Chmarra, Magdalena K.; Hansen, Rune; Mårvik, Ronald; Langø, Thomas


    Medical imaging plays an important role in patients' care and is continuously being used in managing health and disease. To obtain the maximum benefit from this rapidly developing technology, further research is needed. Ideally, this research should be done in a patient-safe and environment-friendly manner; for example, on phantoms. The goal of this work was to develop a protocol and manufacture a multimodal liver phantom that is suitable for ultrasound, computed tomography, and magnetic reso...

  3. Multimodal System for Recommending Music



    Our work discusses development of multimodal music recommendation system. Users of the system are walking on the bridge while using mobile application and the system recommends music according to the walking style, adjusts tempo of the playing song, illuminates the bridge and projects user's positions on the floor. For this particular project we developed electronic boards and used them for all user tracking devices. All electronic boards are merged into common hardware which communicates wit...

  4. Radioactive Nanomaterials for Multimodality Imaging

    Chen, Daiqin; Dougherty, Casey A.; Yang, Dongzhi; Wu, Hongwei; Hong, Hao


    Nuclear imaging techniques, including primarily positron emission tomography (PET) and single-photon emission computed tomography (SPECT), can provide quantitative information for a biological event in vivo with ultra-high sensitivity, however, the comparatively low spatial resolution is their major limitation in clinical application. By convergence of nuclear imaging with other imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI) and optical imaging, the hybrid imaging platforms can overcome the limitations from each individual imaging technique. Possessing versatile chemical linking ability and good cargo-loading capacity, radioactive nanomaterials can serve as ideal imaging contrast agents. In this review, we provide a brief overview about current state-of-the-art applications of radioactive nanomaterials in the circumstances of multimodality imaging. We present strategies for incorporation of radioisotope(s) into nanomaterials along with applications of radioactive nanomaterials in multimodal imaging. Advantages and limitations of radioactive nanomaterials for multimodal imaging applications are discussed. Finally, a future perspective of possible radioactive nanomaterial utilization is presented for improving diagnosis and patient management in a variety of diseases.

  5. Multimodality imaging of pulmonary infarction

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis

  6. Multimodality imaging of pulmonary infarction

    Bray, T.J.P., E-mail: [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)


    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  7. Radiolabeled Nanoparticles for Multimodality Tumor Imaging

    Xing, Yan; Zhao, Jinhua; Conti, Peter S.; Chen, Kai


    Each imaging modality has its own unique strengths. Multimodality imaging, taking advantages of strengths from two or more imaging modalities, can provide overall structural, functional, and molecular information, offering the prospect of improved diagnostic and therapeutic monitoring abilities. The devices of molecular imaging with multimodality and multifunction are of great value for cancer diagnosis and treatment, and greatly accelerate the development of radionuclide-based multimodal mol...

  8. A multimodal restaurant finder for semantic web

    He, Yulan; Quan, Thanh Tho; Hui, Siu Cheung


    Multimodal dialogue systems provide multiple modalities in the form of speech, mouse clicking, drawing or touch that can enhance human-computer interaction. However, one of the drawbacks of the existing multimodal systems is that they are highly domain-specific and they do not allow information to be shared across different providers. In this paper, we propose a semantic multimodal system, called Semantic Restaurant Finder, for the Semantic Web in which the restaurant information in different ...

  9. Multimodal emotion perception after anterior temporal lobectomy

    Valérie Milesi; Chiara Cristinzio; Margitta Seeck


    In the context of emotion information processing, several studies have demonstrated the involvement of the amygdala in emotion perception, for unimodal and multimodal stimuli. However, it seems that not only the amygdala, but several regions around it, may also play a major role in multimodal emotional integration. In order to investigate the contribution of these regions to multimodal emotion perception, five patients who had undergone unilateral anterior temporal lobe resection were exposed...

  10. Decoherence of multimode thermal squeezed coherent states

    Yeh, L.


    It is well known that any multimode positive definite quadratic Hamiltonian can be transformed into a hamiltonian of uncoupled harmonic oscillators. Based on this theorem, the multimode thermal squeezed coherent states are constructed in terms of density operators. Decoherence of multimode thermal squeezed coherent states in investigated via the characteristic function and it is shown that the decohered (reduced) states are still thermal squeezed coherent states in general.

  11. Intensidade da dor e adequação de analgesia Intensidad del dolor y adecuación de la analgesia Pain intensity of pain and adequacy of analgesia

    Ana Maria Calil


    Full Text Available Trata-se de um estudo inédito em nosso meio, no qual, avaliou-se a intensidade da dor e a adequação da analgesia no setor de emergência. Foram avaliadas 100 vítimas de acidentes de transporte atendidas em um hospital de referência para trauma. A dor foi presente em 90,0% dos casos; 56,0% referiram dor intensa na primeira avaliação e, após três horas de observação, 26,0% permaneceram com dor intensa e 38,0% com dor moderada. Uma significativa parte da população do estudo permaneceu sem analgesia durante o período de observação. Números expressivos de inadequação analgésica foram encontrados demonstrando a reduzida importância conferida a analgesia no trauma em nosso meio.Se trata de un estudio inédito en nuestro medio, en el cual se evaluó la intensidad del dolor y el adecuado procedimiento de analgesia en un sector de emergencia. Se evaluó a 100 víctimas de accidentes de tránsito atendidas en un hospital de referencia para trauma. El dolor fue constatado en el 90,0% de los casos. El 56,0% relató dolor intenso en la primera evaluación. Después de 3 horas de observación, el 26,0% permaneció con dolor intenso y el 38,0% con dolor moderado. Una significativa parte de la población estudiada permaneció sin analgesia durante el período de observación. Se encontró números expresivos de analgesia inadecuada, lo que demuestra la reducida importancia que se da a la analgesia en el trauma en nuestro medio.An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found

  12. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    Ali, M


    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  13. "Tem mulher, tem preventivo": sentidos das práticas preventivas do câncer do colo do útero entre mulheres de Salvador, Bahia, Brasil

    Ana María Rico


    Full Text Available O objetivo deste trabalho foi compreender os significados das práticas preventivas do câncer do colo do útero entre mulheres de bairros populares de Salvador, Bahia, Brasil. Trata-se de estudo qualitativo, baseado na análise de conteúdo de entrevistas semiestruturadas com 15 mulheres entre 24 e 68 anos. Os resultados evidenciam alta valorização do Papanicolaou, que é realizado como parte de exames de rotina, sem, no entanto, sustentar-se no conhecimento biomédico sobre as suas funções. Além da acessibilidade aos serviços de saúde e da qualidade destes, outros fatores interferem na forma como essas mulheres significam a prevenção do câncer do colo do útero. Valores morais associados à sexualidade e ao gênero interferem na percepção de risco, na adoção de práticas preventivas e na interpretação dos resultados da citologia cervical. A realização continuada do Papanicolaou faz parte da construção da feminilidade, que é associada com maturidade e responsabilidade pessoal pelo cuidado de si em um contexto de medicalização do corpo feminino.

  14. Phase 1 development of an index to measure the quality of neuraxial labour analgesia: exploring the perspectives of childbearing women

    Angle, Pamela; Landy, Christine Kurtz; Charles, Cathy; Yee, Jennifer; Watson, Jo; Kung, Rose; Kronberg, Jean; Halpern, Stephen; Lam, Desmond; Lie, Lie Ming; Streiner, David


    Purpose Modern neuraxial labour analgesia reflects a shift in obstetrical anesthesia thinking – away from a simple focus on pain relief towards a focus on the overall quality of analgesia. However, advances in the methods used to measure outcomes have not kept pace with clinical progress, and these approaches must evolve to facilitate meaningful assessment of the advances provided towards the quality of analgesia. Developing a tool to measure the quality of neuraxial labour analgesia that res...

  15. The effect of adding epinephrine to combination of sufentanil and bupivacaine in spinal analgesia during labor

    Parisa Golfam


    Full Text Available Background: Spinal analgesia is one of the effective and rapid methods for labor. It is not commonly used because of short duration of analgesia and motor block, which limits mother's force in labor progression. We attempted to prolong duration and quality of analgesia by adding Epinephrine.Methods: In this quasi-experimental study 90 pregnant women gravid II and III who referred to Motazedi and Imam Reza Educational & Medical Centers were recruited and divided into two groups of case and control (45 subjects in each group. The case group received spinal analgesia using Sufentanil and Bupivacaine, and Epinephrine while the control group received Sufentanil and Bupivacaine. Data including feeling of pain, motor block, duration of analgesia, fetal heart rate, nausea and vomiting, blood pressure was collected and analyzed using chi-square and t test. Results: duration of analgesia and vomiting were significantly increased in the case group. (p=0.001, p=0.01 respectively. Hemodynamic status in mothers and Apgar score of neonates were not significantly different between two groups.Conclusion: It seems that adding Epinephrine to Sufentanil and Bupivacaine could increase analgesia duration without altering in sensory level although could increase nausea and vomiting its recommended in labor analgesia.

  16. 21 CFR 868.5160 - Gas machine for anesthesia or analgesia.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gas machine for anesthesia or analgesia. 868.5160... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5160 Gas machine for anesthesia or analgesia. (a) Gas machine for anesthesia—(1) Identification. A gas machine for anesthesia is...

  17. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    Mogensen, T; Hjortsø, N C; Bigler, D;


    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

  18. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas

    Eriksen, Lena Mariann; Nøhr, Ellen Aagaard; Kjaergaard, Hanne


    Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between...

  19. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne; Jensen, Pia Søe; Kehlet, Henrik


    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the...... effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

  20. To study the acceptance of epidural analgesia for painless labor at a tertiary care centre

    Neena Gupta


    Full Text Available Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labor. Epidural analgesia is the most effective method of pain relief during labor. But unfortunately in India incidence of painless labor by epidural analgesia is very rare even in these days. The aim of our study was to study the acceptance of epidural analgesia at a tertiary care centre. Methods: The present study was conducted in department of obstetrics and gynaecology UISEMH, Kanpur over the period from May 2012 to May 2013. The study was conducted on 98 patients who were counselled regarding the adoption of epidural analgesia as painless labour and out of these 50 patients opted for epidural analgesia. Results: In our present study the acceptance was greater in primigravida (72.43% as compared to multigravida (20%. In our society social reason was the common cause for non-acceptance in primigravida (87.5%. The majority of patients belonged to middle socioeconomic status (52% and more number of educated patients opted for epidural analgesia. Conclusions: It was found that increased awareness can lead to increased acceptance of epidural analgesia. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1087-1089

  1. A compression bandage improves local infiltration analgesia in total knee arthroplasty

    Andersen, Lasse; Husted, Henrik; Otte, Niels Kristian Stahl Kri; Kristensen, Billy Bjarne; Kehlet, Henrik


    BACKGROUND: High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated. METHODS: 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0.2% rop...

  2. Patient-Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement

    Patti Kastanias


    Full Text Available PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN-administered oral analgesia.

  3. The impact of patients controlled analgesia undergoing orthopedic surgery

    Aluane Silva Dias


    Full Text Available ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen, and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA and total knee arthroplasty (TKA, thoracolumbar spine arthrodesis (long PVA, cervical spine arthrodesis (cervical AVA and lumbar spine arthrodesis (lumbar PVA. RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03 and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09. CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

  4. High-volume infiltration analgesia in bilateral hip arthroplasty

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik; Gaarn-Larsen, Lissi; Kristensen, Billy; Kehlet, Henrik


    instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...... acetaminophen....

  5. Regional anaesthesia and analgesia on the front line.

    Scott, D M


    Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier PMID:20014611

  6. Local infiltration analgesia in hip and knee arthroplasty: an emerging technique.

    Dillon, John P; Brennan, Louise; Mitchell, David


    The optimal form of post-operative analgesia in hip and knee arthroplasty is still debated. Traditionally, patient-controlled analgesia and epidural anaesthesia were used. Potential side-effects such as nausea, confusion, urinary retention, hypotension and immobility have resulted in the emergence of newer techniques that limit opioid use. Peripheral nerve blockade provides excellent analgesia but limits patient ability to ambulate in the immediate post-operative period. Local infiltrative analgesia (LIA) is an emerging technique that has shown to provide superior analgesia, higher patient satisfaction and earlier discharge from hospital when compared to some of the more traditional methods. This review article highlights the advantages of LIA in hip and knee arthroplasty surgery. We describe the technique used, including additional measures that aid early ambulation and discharge from hospital in this cohort of patients. PMID:22696983




    scores compared to non - block group , p value being < 0.001. Total requirement of opioids in 24 hours was reduced in the block group , p<0.001. Time to first request for analgesia was delayed in the block gr oup where only 22% patients needed analgesic at 0 hours compared to 72% in non - block group . Incidence of nausea and vomiting was reduced after 4 hours in block group. The non - block group patients were less sedated at 0 and 2 hours probably due to pain . The re were no complications attributable to the block. CONCLUSION : TAP block as a complementary technique to the multimodal analgesia protocol , provided improved quality of analgesia with reduced opioid requirement and their side effects in block group compar ed to non - block group for radical hysterectomy and pelvic lymph node dissection with incision below the umbilicus

  8. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study


    It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared...

  9. Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study

    Rasmussen, Michael; Mathiesen, Ole; Dierking, Gerd;


    It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared...... with paracetamol and ketorolac alone after hip arthroplasty....

  10. Multimodality, Literacy and Texts: Developing a Discourse

    Bearne, Eve


    This article argues for the development of a framework through which to describe children's multimodal texts. Such a shared discourse should be capable of including different modes and media and the ways in which children integrate and combine them for their own meaning-making purposes. It should also acknowledge that multimodal texts are not…

  11. Complex bounds for multimodal maps: bounded combinatorics

    Smania, Daniel


    We proved the so called complex bounds for multimodal, infinitely renormalizable analytic maps with bounded combinatorics: deep renormalizations have polynomial-like extensions with definite modulus. The complex bounds is the first step to extend the renormalization theory of unimodal maps to multimodal maps.

  12. A Cuckoo Search Algorithm for Multimodal Optimization

    Erik Cuevas


    Full Text Available Interest in multimodal optimization is expanding rapidly, since many practical engineering problems demand the localization of multiple optima within a search space. On the other hand, the cuckoo search (CS algorithm is a simple and effective global optimization algorithm which can not be directly applied to solve multimodal optimization problems. This paper proposes a new multimodal optimization algorithm called the multimodal cuckoo search (MCS. Under MCS, the original CS is enhanced with multimodal capacities by means of (1 the incorporation of a memory mechanism to efficiently register potential local optima according to their fitness value and the distance to other potential solutions, (2 the modification of the original CS individual selection strategy to accelerate the detection process of new local minima, and (3 the inclusion of a depuration procedure to cyclically eliminate duplicated memory elements. The performance of the proposed approach is compared to several state-of-the-art multimodal optimization algorithms considering a benchmark suite of fourteen multimodal problems. Experimental results indicate that the proposed strategy is capable of providing better and even a more consistent performance over existing well-known multimodal algorithms for the majority of test problems yet avoiding any serious computational deterioration.

  13. A cuckoo search algorithm for multimodal optimization.

    Cuevas, Erik; Reyna-Orta, Adolfo


    Interest in multimodal optimization is expanding rapidly, since many practical engineering problems demand the localization of multiple optima within a search space. On the other hand, the cuckoo search (CS) algorithm is a simple and effective global optimization algorithm which can not be directly applied to solve multimodal optimization problems. This paper proposes a new multimodal optimization algorithm called the multimodal cuckoo search (MCS). Under MCS, the original CS is enhanced with multimodal capacities by means of (1) the incorporation of a memory mechanism to efficiently register potential local optima according to their fitness value and the distance to other potential solutions, (2) the modification of the original CS individual selection strategy to accelerate the detection process of new local minima, and (3) the inclusion of a depuration procedure to cyclically eliminate duplicated memory elements. The performance of the proposed approach is compared to several state-of-the-art multimodal optimization algorithms considering a benchmark suite of fourteen multimodal problems. Experimental results indicate that the proposed strategy is capable of providing better and even a more consistent performance over existing well-known multimodal algorithms for the majority of test problems yet avoiding any serious computational deterioration. PMID:25147850

  14. Advances in Multimodality Molecular Imaging

    Multimodality molecular imaging is now playing a pivotal role in clinical setting and biomedical research. Modern molecular imaging technologies are deemed to potentially lead to a revolutionary paradigm shift in healthcare and revolutionize clinical practice. Within the spectrum of macroscopic medical imaging, sensitivity ranges from the detection of millimolar to submillimolar concentrations of contrast media with computed tomography (CT) and magnetic resonance imaging (MRI), respectively, to picomolar concentrations in single-photon emission computed tomography (SPECT) and positron emission 8 9 tomography (PET): a 108-109 difference. Even though the introduction of dedicated dual-modality imaging systems designed specifically and available commercially for clinical practice is relatively recent, the concept of combining anatomical and functional imaging has been recognized for several decades. Software- and hardware-based correlation between anatomical (x-ray CT, MRI) and physiological (PET) information is a promising research field and now offers unique capabilities for the medical imaging community and biomedical researchers. The introduction of dual-modality PET/CT imaging systems in clinical environments has revolutionized the practice of diagnostic imaging. The complementarity between the intrinsically aligned anatomic (CT) and functional or metabolic (PET) information provided in a 'one-stop shop' and the possibility to use CT images for attenuation correction of the PET data has been the driving force behind the success of this technology. On the other hand, combining PET with Magnetic Resonance Imaging (MRI) in a single gantry is technically more challenging owing to the strong magnetic fields. Nevertheless, significant progress has been made resulting in the design of few preclinical PET systems and one human prototype dedicated for simultaneous PET/MR brain imaging where the first patient images have been shown late in 2006. This paper discusses the

  15. Multifuel multimodal network design; Projeto de redes multicombustiveis multimodal

    Lage, Carolina; Dias, Gustavo; Bahiense, Laura; Ferreira Filho, Virgilio J.M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Coordenacao dos Programas de Pos-graduacao de Engenharia (COPPE). Programa de Engenharia de Producao


    The objective of the Multi commodity Multimodal Network Project is the development of modeling tools and methodologies for the optimal sizing of production networks and multimodal distribution of multiple fuel and its incomes, considering investments and transportation costs. Given the inherently non-linear combinatory nature of the problem, the resolution of real instances by the complete model, in an exact way, becomes computationally intractable. Thus, the strategy for resolution should contain a combination of exacts and heuristics methods, that must be applied to subdivisions of the original problem. This paper deals with one of these subdivisions, tackling the problem of modeling a network of pipelines in order to drain the production of ethanol away from the producing plants. The objective consists in defining the best network topology, minimizing investment and operational costs, and attending the total demand. In order to do that, the network was considered a tree, where the nodes are the center of producing regions and the edges are the pipelines, trough where the ethanol produced by plants must be drained away. The main objective also includes the decision over the optimal diameter of each pipeline and the optimal size of the bombs, in order to minimize the pumping costs. (author)


    Catalin LUPU


    This paper presents the use of multimodal biometrics in order to identify or to verify a person that wants to start the engine of a car. First of all, a fingerprint sensor is posted on the car’s door, one on the steering wheel, a camera for iris recognition on the car's main mirror, and finally a microphone for voice recognition. There are two possibilities: if the person is identified as the car owner or a known user, then he/she can take control over the car; if it’s an intruder, the car ca...

  17. Multimodal interactive handwritten text transcription

    Romero, Veronica; Vidal, Enrique


    This book presents an interactive multimodal approach for efficient transcription of handwritten text images. This approach, rather than full automation, assists the expert in the recognition and transcription process.Until now, handwritten text recognition (HTR) systems are far from being perfect and heavy human intervention is often required to check and correct the results of such systems. The interactive scenario studied in this book combines the efficiency of automatic handwriting recognition systems with the accuracy of the experts, leading to a cost-effective perfect transcription of th

  18. Metawidgets in the multimodal interface

    Blattner, M.M. (Lawrence Livermore National Lab., CA (United States) Anderson (M.D.) Cancer Center, Houston, TX (United States)); Glinert, E.P.; Jorge, J.A.; Ormsby, G.R. (Rensselaer Polytechnic Inst., Troy, NY (United States). Dept. of Computer Science)


    We analyze two intertwined and fundamental issues concerning computer-to-human communication in the multimodal interfaces: the interplay between sound and graphics, and the role of object persistence. Our observations lead us to introduce metawidgets as abstract entities capable of manifesting themselves to users as image, as sound, or as various combinations and/or sequences of the two media. We show examples of metawidgets in action, and discuss mechanisms for choosing among alternative media for metawidget instantiation. Finally, we describe a couple of experimental microworlds we have implemented to test out some of our ideas. 17 refs., 7 figs.

  19. Modal dynamics in multimode fibers

    Fridman, Moti; Nixon, Micha; Friesem, Asher A; Davidson, Nir


    The dynamics of modes and their states of polarizations in multimode fibers as a function of time, space, and wavelength are experimentally and theoretically investigated. The results reveal that the states of polarizations are displaced in Poincare sphere representation when varying the angular orientations of the polarization at the incident light. Such displacements, which complicates the interpretation of the results, are overcome by resorting to modified Poincare spheres representation. With such modification it should be possible to predict the output modes and their state of polarization when the input mode and state of polarization are known.

  20. [Fentanyl in peridural obstetrical analgesia. Evaluation after 4 years' use].

    Lévêque, C; Garen, C; Pathier, D; Mazuir, E; Maneglia, R; Janse-Marec, J; Cousin, M T


    7,500 deliveries occurred from the date of opening of the Maternity Hospital Jean-Rostand. 3,500 of these were conducted under epidural anaesthesia. At different stages prospective studies were carried out to recall the effect of adding fentanyl to bupivacaine when the epidural injection was made. A pharmacokinetic study. This shows that the levels in the mother and the fetus begin to coincide more with the number of doses that are given and pass from 0.3 after 50 micrograms have been administered to 0.5 after 100 micrograms have been administered and 0.7 after 150 micrograms have been administered. The fetal levels are far lower than those required to depress respiration. The half life of distribution through the circulation has been worked out at 4 minutes and the half for elimination of the drug at 460 minutes. The maternal levels show great fluctuations and late alterations. Analgesia is earlier, more complete and more prolonged when fentanyl is added. Fentanyl also masks irregularities. Undesirable effects such as tiredness, pruritus, nausea, vomiting and urinary retention occur infrequently and last only for short periods of time. No mother had respiratory depression. The doses of bupivacaine that had to be given were as a whole less when fentanyl was added. In 40% of cases it only required one injection to achieve analgesia throughout the whole labour. The length of labour and the number of caesarean operations carried out did not change.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3584862

  1. [Perioperative analgesia with continuous peripheral nerve blocks in children].

    Dadure, C; Capdevila, X


    Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain. PMID:17174518

  2. Analgesia PCA por catéter interesternocleidomastoideo frente analgesia PCA intravenosa tras cirugía proximal de húmero Continuous Intersternocleidomastoid PCA analgesia Vs intravenous PCA analgesia after proximal shoulder surgery

    R. Ortiz de la Tabla


    Full Text Available Introducción: Comparar la eficacia analgésica e incidencia de efectos adversos entre el bloqueo interesternocleidomastoideo continuo y una pauta analgésica intravenosa tras cirugía proximal de húmero. Material y Métodos: Estudio prospectivo descriptivo no aleatorizado de pacientes intervenidos de cirugía de hombro bajo anestesia general con fentanilo intravenoso como analgesia intraoperatoria. Al grupo 1 se realizó bloqueo interesternocleidomastoideo con ropivacaína 0,5% 0,4 mL Kg-1 y en URPA se comenzó una perfusión de ropivacaína 0,2% 5mL h-1, con bolos PCA 5 mL y tiempo de cierre de 30 minutos. Al grupo 2, a su llegada a la URPA se administró una dosis carga de metamizol 2 gr, tramadol 100 mgr y ondansetrón 4 mgr, seguido por una perfusión de metamizol 0,16%, tramadol 0,04% y ondansetrón 0,0016% a 1,5 mL h-1 bolos PCA 1 mL y tiempo de cierre 20 minutos. La variable principal fue la valoración del dolor postoperatorio, en reposo y movimiento, mediante escala verbal numérica de 0 (no dolor a 10 (máximo dolor y la aparición de efectos indeseables. Resultados: Se incluyeron 38 pacientes en el grupo 1 y 39 en el 2. La valoración del dolor postoperatorio puso de manifiesto valores más elevados en las primeras 24 horas al movimiento y a las 48 horas, tanto en reposo como al movimiento, en el grupo 2 (pObjectives: We have compared results in postoperative analgesia and incidence of side effects between a continuous intersternocleidotnastoid blockade and intravenous analgesia after proximal shoulder surgery. Methods: In a prospective no randomized study on patients scheduled for unilateral shoulder surgery under general anaesthesia with intravenous fentanil as intraoperative analgesia. In group 1, a continuous intersternocleidomastoid blockade was performed with a bolus of ropivacaine 0,5% 0,4 mL/kg before surgery and a postoperative patient-controlled analgesia (PCA infusión pump of 0,2% ropivacaine (5ml/h, PCA bolus 5 mi / 30

  3. Cardiac imaging. A multimodality approach

    An excellent atlas on modern diagnostic imaging of the heart Written by an interdisciplinary team of experts, Cardiac Imaging: A Multimodality Approach features an in-depth introduction to all current imaging modalities for the diagnostic assessment of the heart as well as a clinical overview of cardiac diseases and main indications for cardiac imaging. With a particular emphasis on CT and MRI, the first part of the atlas also covers conventional radiography, echocardiography, angiography and nuclear medicine imaging. Leading specialists demonstrate the latest advances in the field, and compare the strengths and weaknesses of each modality. The book's second part features clinical chapters on heart defects, endocarditis, coronary heart disease, cardiomyopathies, myocarditis, cardiac tumors, pericardial diseases, pulmonary vascular diseases, and diseases of the thoracic aorta. The authors address anatomy, pathophysiology, and clinical features, and evaluate the various diagnostic options. Key features: - Highly regarded experts in cardiology and radiology off er image-based teaching of the latest techniques - Readers learn how to decide which modality to use for which indication - Visually highlighted tables and essential points allow for easy navigation through the text - More than 600 outstanding images show up-to-date technology and current imaging protocols Cardiac Imaging: A Multimodality Approach is a must-have desk reference for cardiologists and radiologists in practice, as well as a study guide for residents in both fields. It will also appeal to cardiac surgeons, general practitioners, and medical physicists with a special interest in imaging of the heart. (orig.)

  4. Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

    Torvaldsen Siranda


    Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

  5. NCG51/4: Modificaci??n del plan de estudio del M??ster universitario en Investigaci??n y Avances en Medicina Preventiva y Salud P??blica.

    Universidad de Granada


    Aprobaci??n de Modificaci??n del plan de estudio del M??ster universitario en Investigaci??n y Avances en Medicina Preventiva y Salud P??blica, aprobado en sesi??n extraordinaria del Consejo de Gobierno de la Universidad de Granada celebrado el 20 de diciembre de 2011.

  6. Vectores recombinantes basados en el virus modificado de ankara (MVA) como vacunas preventivas y terapéuticas contra el SIDA

    Jonathan L Heeney; Mooij, Petra; Nájera García, José Luis; Jiménez, Victoria; Esteban, Mariano; Gómez, Carmen E.


    Vectores Recombinantes basados en el Virus Modificado de Ankara (MVA) como Vacunas Preventivas y Terapéuticas contra el SIDA. Losvirus recombinantes de la invención contienen secuencias que se encuentran insertadas en el mismo sitio de inserción del MVA y permiten la expresión simultánea de varios antígenos, una proteína Env del VIH-I consistente en una proteína gpl20 carente de secuencias correspondientes a la proteína gp41, y una proteína quiméricade fusión de Gag, Pol y Nef. Son virus esta...

  7. Tibial cortical lesions: A multimodality pictorial review

    Tyler, P.A., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Mohaghegh, P., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Foley, J., E-mail: [Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES (United Kingdom); Isaac, A., E-mail: [Department of Radiology, King' s College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Zavareh, A., E-mail: [Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE (United Kingdom); Thorning, C., E-mail: [Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH (United Kingdom); Kirwadi, A., E-mail: [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Pressney, I., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Amary, F., E-mail: [Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Rajeswaran, G., E-mail: [Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH (United Kingdom)


    Highlights: • Multimodality imaging plays an important role in the investigation and diagnosis of shin pain. • We review the multimodality imaging findings of common cortically based tibial lesions. • We also describe the rarer pathologies of tibial cortical lesions. - Abstract: Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.

  8. Tibial cortical lesions: A multimodality pictorial review

    Highlights: • Multimodality imaging plays an important role in the investigation and diagnosis of shin pain. • We review the multimodality imaging findings of common cortically based tibial lesions. • We also describe the rarer pathologies of tibial cortical lesions. - Abstract: Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department

  9. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model

    Ravn, Pernille; Secher, EL; Skram, U;


    Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than μ-opioid receptor agonists. The primary outcome of this study was therefore to...... investigate relative differences in antihyperalgesia and analgesia effects between morphine and buprenorphine in an inflammatory pain model in volunteers. The secondary outcome was to examine the relationship between pain sensitivity and opioid-induced effects on analgesia, antihyperalgesia, and descending...... pain modulation....

  10. Nonlinear multimodal interference and saturable absorption using a short graded-index multimode optical fiber

    Nazemosadat, Elham; Mafi, Arash


    A detailed investigation of the nonlinear multimodal interference in a short graded-index multimode optical fiber is presented. The analysis is performed for a specific device geometry, where the light is coupled in and out of the multimode fiber via single-mode fibers. The same device geometry was recently used to obtain ultra-low-loss coupling between two single-mode optical fibers with very different mode-field diameters. Our results indicate the potential application of this simple geomet...

  11. Analgesia del Trabajo de Parto con Remifentanilo por vía intravenosa mediante un Sistema de Analgesia Controlada por la Paciente (PCIA Labour analgesia with Remifentanil by PCIA

    J. M. López-Millán


    Full Text Available Objetivo: Valorar la eficacia analgésica y seguridad en el parto de Remifentanilo por vía intravenosa mediante un sistema de analgesia controlada por la paciente. Material y Método: El grupo de estudio lo componen 25 gestantes sanas, primigestas a término, con parto eutócico instaurado, que solicitan analgesia durante el trabajo de parto. Resultados: Se produce un alivio significativo del dolor desde la primera hora de tratamiento en todos los casos. La analgesia se mantiene hasta el final en el 80% de los casos. El 20% restante solicitó anestesia regional en el período expulsivo. Se produjo un grado de sedación de leve a moderado durante todo el estudio, que las pacientes valoraron positivamente. Solo en dos casos el grado de sedación fue moderado-severo, a pesar de lo cual las gestantes decidieron continuar en el estudio. No se registraron efectos adversos materno-fetales. Conclusiones: La analgesia del parto con Remifentanilo por vía intravenosa controlada por la paciente es un método efectivo y presenta un aceptable perfil de seguridad materno y fetal.Objective: To assess the analgesic efficacy of patient-controlled in-travenous analgesia with remifentanil and its potential side effects during labour. Method: We analyzed 25 healthy nulliparas at full term pregnancy, in established uncomplicated labour, who demanded pain relief. Results: All the patients experienced a significant pain relief during the first hour of treatment which was maintained on until delivery on 80%. The other 20% required additional regional anaesthesia at the end of second stage. The level of sedation was mild to moderate and treatment was well tolerated except for two, who presented heavy sedation. No maternal or neonatal side effects were registered. Conclusions: Patient-controlled intravenous analgesia with remifentanil is effective for labour pain relief and produces no major maternal and neonatal side effects.

  12. Brain Multimodality Monitoring: Updated Perspectives

    Roh, David


    The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected through physiologic changes. These changes serve as a surrogate for tissue injury/cell death and are captured by parameters measured by various monitors that measure intracranial pressure (ICP), cerebral blood flow (CBF), brain tissue oxygenation (PbtO2), cerebral metabolism, and electrocortical activity. In the ideal setting, multimodality monitoring (MMM) integrates these neurological monitoring parameters with traditional hemodynamic monitoring and the physical exam, presenting the information needed to clinicians who can intervene before irreversible damage occurs. There are now consensus guidelines on the utilization of MMM, and there continue to be new advances and questions regarding its use. In this review, we examine these recommendations, recent evidence for MMM, and future directions for MMM. PMID:27095434

  13. DBSAR's First Multimode Flight Campaign

    Rincon, Rafael F.; Vega, Manuel; Buenfil, Manuel; Geist, Alessandro; Hilliard, Lawrence; Racette, Paul


    The Digital Beamforming SAR (DBSAR) is an airborne imaging radar system that combines phased array technology, reconfigurable on-board processing and waveform generation, and advances in signal processing to enable techniques not possible with conventional SARs. The system exploits the versatility inherently in phased-array technology with a state-of-the-art data acquisition and real-time processor in order to implement multi-mode measurement techniques in a single radar system. Operational modes include scatterometry over multiple antenna beams, Synthetic Aperture Radar (SAR) over several antenna beams, or Altimetry. The radar was flight tested in October 2008 on board of the NASA P3 aircraft over the Delmarva Peninsula, MD. The results from the DBSAR system performance is presented.

  14. [Multimodal pain therapy. Current situation].

    Kaiser, U; Sabatowski, R; Azad, S C


    A multidisciplinary approach for the management of patients with chronic pain is now well-established in many countries, especially in situations involving a complex disease process in the sense of a biopsychosocial model. Both the efficacy and cost-effectiveness of multidisciplinary pain treatment programs and their superiority compared to unimodal therapy has been documented in a number of studies, reviews and meta-analyses, in particular for patients suffering from chronic low back pain. Nevertheless, there are still major shortcomings concerning the definition of multimodal and multidisciplinary treatment and the quality of structures and processes, compared for example to the standards defined by the German Pain Society (Deutsche Schmerzgesellschaft). Furthermore, there is still no consensus on specific therapeutic approaches, the differentiation between responders and non-responders as well as on the tools required for measurement. All these questions will have to be answered by concerted efforts in a multicenter setting. PMID:26271912

  15. Multimode waveguide based directional coupler

    Ahmed, Rajib; Rifat, Ahmmed A.; Sabouri, Aydin; Al-Qattan, Bader; Essa, Khamis; Butt, Haider


    The Silicon-on-Insulator (SOI) based platform overcomes limitations of the previous copper and fiber based technologies. Due to its high index difference, SOI waveguide (WG) and directional couplers (DC) are widely used for high speed optical networks and hybrid Electro-Optical inter-connections; TE00-TE01, TE00-TE00 and TM00-TM00 SOI direction couplers are designed with symmetrical and asymmetrical configurations to couple with TE00, TE01 and TM00 in a multi-mode semi-triangular ring-resonator configuration which will be applicable for multi-analyte sensing. Couplers are designed with effective index method and their structural parameters are optimized with consideration to coupler length, wavelength and polarization dependence. Lastly, performance of the couplers are analyzed in terms of cross-talk, mode overlap factor, coupling length and coupling efficiency.

  16. Multimode optical fiber based spectrometers

    Redding, Brandon; Cao, Hui


    A standard multimode optical fiber can be used as a general purpose spectrometer after calibrating the wavelength dependent speckle patterns produced by interference between the guided modes of the fiber. A transmission matrix was used to store the calibration data and a robust algorithm was developed to reconstruct an arbitrary input spectrum in the presence of experimental noise. We demonstrate that a 20 meter long fiber can resolve two laser lines separated by only 8 pm. At the other extreme, we show that a 2 centimeter long fiber can measure a broadband continuous spectrum generated from a supercontinuum source. We investigate the effect of the fiber geometry on the spectral resolution and bandwidth, and also discuss the additional limitation on the bandwidth imposed by speckle contrast reduction when measuring dense spectra. Finally, we demonstrate a method to reduce the spectrum reconstruction error and increase the bandwidth by separately imaging the speckle patterns of orthogonal polarizations. The mu...

  17. Multimodal integration in statistical learning

    Mitchell, Aaron; Christiansen, Morten Hyllekvist; Weiss, Dan


    , we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker’s face. In the critical condition, the visual (e.g., /gi/) and auditory (e.g., /mi/) signals were occasionally...... facilitated participants’ ability to segment the speech stream. Our results therefore demonstrate that participants can integrate audio and visual input to perceive the McGurk illusion during statistical learning. We interpret our findings as support for modality-interactive accounts of statistical learning.......Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study...

  18. Imaging-guided hyperstimulation analgesia in low back pain

    Gorenberg M


    Full Text Available Miguel Gorenberg,1,2 Kobi Schwartz31Department of Nuclear Medicine, B'nai Zion Medical Center, Haifa, Israel; 2The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; 3Department of Physical Therapy, B'nai Zion Medical Center, Haifa, IsraelAbstract: Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.Keywords: myofascial, noninvasive, electrical, impedance

  19. The Role for Epigenetic Modifications in Pain and Analgesia Response

    Sherrie Lessans


    Full Text Available Pain remains a poorly understood and managed symptom. A limited mechanistic understanding of interindividual differences in pain and analgesia response shapes current approaches to assessment and treatment. Opportunities exist to improve pain care through increased understanding of how dynamic epigenomic remodeling shapes injury, illness, pain, and treatment response. Tightly regulated alterations of the DNA-histone chromatin complex enable cells to control transcription, replication, gene expression, and protein production. Pathological alterations to chromatin shape the ability of the cell to respond to physiologic and environmental cues leading to disease and reduced treatment effectiveness. This review provides an overview of critical epigenetic processes shaping pathology and pain, highlights current research support for the role of epigenomic modification in the development of chronic pain, and summarizes the therapeutic potential to alter epigenetic processes to improve health outcomes.

  20. Controversy of the use of epidural analgesia in labour

    Enrique Ramón Arbués


    Full Text Available During last years, it was thought that free-pain labour was a big advance for woman. Recently, ideological patrons such as ecofeminism have feed a critical mind in the woman who is going to give birth. In this bibliographic review we don’t approach a reliable and definitive conclusion, due to the bias and lack of scientific rigour of some studies and the doubtful methodological reliability and generalization of others.This way, we conclude the need to make a tolerant effort on the part of everyone, just as researching and assuming on the services portfolio (if needed alternative techniques such as combined spinal-epidural analgesia, sterile water injections, water immersion, acupuncture, hypnosis, etc.

  1. Glia: novel counter-regulators of opioid analgesia.

    Watkins, Linda R; Hutchinson, Mark R; Johnston, Ian N; Maier, Steven F


    Development of analgesic tolerance and withdrawal-induced pain enhancement present serious difficulties for the use of opioids for pain control. Although neuronal mechanisms to account for these phenomena have been sought for many decades, their bases remain unresolved. Within the past four years, a novel non-neuronal candidate has been uncovered that opposes acute opioid analgesia and contributes to development of opioid tolerance and tolerance-associated pain enhancement. This novel candidate is spinal cord glia. Glia are important contributors to the creation of enhanced pain states via the release of neuroexcitatory substances. New data suggest that glia also release neuroexcitatory substances in response to morphine, thereby opposing its effects. Controlling glial activation could therefore increase the clinical utility of analgesic drugs. PMID:16246435

  2. Multispectral analysis of multimodal images

    An increasing number of multimodal images represent a valuable increase in available image information, but at the same time it complicates the extraction of diagnostic information across the images. Multispectral analysis (MSA) has the potential to simplify this problem substantially as unlimited number of images can be combined, and tissue properties across the images can be extracted automatically. Materials and methods. We have developed a software solution for MSA containing two algorithms for unsupervised classification, an EM-algorithm finding multinormal class descriptions and the k-means clustering algorithm, and two for supervised classification, a Bayesian classifier using multinormal class descriptions and a kNN-algorithm. The software has an efficient user interface for the creation and manipulation of class descriptions, and it has proper tools for displaying the results. Results. The software has been tested on different sets of images. One application is to segment cross-sectional images of brain tissue (T1- and T2-weighted MR images) into its main normal tissues and brain tumors. Another interesting set of images are the perfusion maps and diffusion maps, derived images from raw MR images. The software returns segmentation that seem to be sensible. Discussion. The MSA software appears to be a valuable tool for image analysis with multimodal images at hand. It readily gives a segmentation of image volumes that visually seems to be sensible. However, to really learn how to use MSA, it will be necessary to gain more insight into what tissues the different segments contain, and the upcoming work will therefore be focused on examining the tissues through for example histological sections

  3. Blockade of tolerance to morphine analgesia by cocaine.

    Misra, A L; Pontani, R B; Vadlamani, N L


    Tolerance to morphine analgesia was induced in male Sprague-Dawley rats by s.c. implantation of a morphine base pellet (75 mg) on the first and second day and determining the magnitude of tolerance 72 h after the first implant by s.c. injection of a test dose of morphine (5 mg/kg). Implantation of a cocaine hydrochloride pellet (25 mg), concurrently with morphine pellets or of a cocaine hydrochloride (50 mg) pellet after the development of tolerance, blocked both the development and expression of morphine analgesic tolerance. In morphine-pelleted animals pretreatment for 3 days with desipramine or zimelidine or phenoxybenzamine but not haloperidol produced no significant morphine tolerance. Pretreatment with a combination of desipramine and zimelidine, however, was as effective as cocaine in blocking morphine tolerance. Alpha-Methyl-p-tyrosine methyl ester counteracted the effect of cocaine in blocking morphine tolerance and potentiated the tolerance development. Blockade of morphine tolerance by cocaine was reinforced and facilitated by pretreatment with fenfluramine or p-chlorophenylalanine ethyl ester and to a lesser extent by clonidine and haloperidol. Acute administration of fenfluramine or zimelidine or a combination of desipramine and zimelidine or alpha-methyl-p-tyrosine methyl ester or p-chlorophenylalanine ethyl ester did not significantly affect morphine analgesia. The study suggests an important role of the concomitant depletion of both central noradrenaline and serotonin in the blockade of morphine tolerance by cocaine and stresses the importance of the counter-balancing functional relationship between these two neurotransmitters in the central nervous system. PMID:2780065

  4. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty

    Gabriela R Lauretti


    Full Text Available Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml. The control group (CG received saline as IT test drug. The morphine group (MG received IT 200 g morphine, the ketorolac group (KG IT 2 mg ketorolac and the morphine-ketorolac group (MKG 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P < 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively. Both groups were longer when compared to the CG (170 ± 13 min (P < 0.01. The MG and KG had lesser ketoprofen consumption compared to the CG (P < 0.05. The time to first rescue analgesic was longer to the MKG (926 ± 222 min (15 h compared to CG (P < 0.001 and to the MG and the KG (P < 0.01. MKG displayed lesser ketoprofen consumption compared to MG and KG (P < 0.05 and to the CG (P < 0.02. Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.

  5. A C++ library for Multimodal Deep Learning

    Jin, Jian


    MDL, Multimodal Deep Learning Library, is a deep learning framework that supports multiple models, and this document explains its philosophy and functionality. MDL runs on Linux, Mac, and Unix platforms. It depends on OpenCV.

  6. Intelligent Multimodal Signal Adaptation System Project

    National Aeronautics and Space Administration — Micro Analysis and Design (MA&D) is pleased to submit this proposal to design an Intelligent Multimodal Signal Adaptation System. This system will dynamically...

  7. Multi-Modal Treatment of Nocturnal Enuresis.

    Mohr, Caroline; Sharpley, Christopher F.


    The article reports a multimodal treatment of nocturnal enuresis and anxious behavior in a mildly mentally retarded woman. Behavioral treatment and removal of caffeine from the subject's diet eliminated both nocturnal enuresis and anxious behavior. (Author/DB)

  8. Multimodal Event Detection in Twitter Hashtag Networks

    Yilmaz, Yasin; Hero, Alfred


    Event detection in a multimodal Twitter dataset is considered. We treat the hashtags in the dataset as instances with two modes: text and geolocation features. The text feature consists of a bag-of-words representation. The geolocation feature consists of geotags (i.e., geographical coordinates) of the tweets. Fusing the multimodal data we aim to detect, in terms of topic and geolocation, the interesting events and the associated hashtags. To this end, a generative latent variable model is as...

  9. Multimodal Interaction: Intuitive, Robust, and Preferred?

    Naumann, Anja B.; Wechsung, Ina; Hurtienne, Jörn

    We investigated if and under which conditions multimodal interfaces (touch, speech, motion control) fulfil the expectation of being superior to unimodal interfaces. The results show that the possibility of multimodal interaction with a handheld mobile device turned out to be more intuitive, more robust, and more preferred than the interaction with the individual modalities speech and motion control. However, it was not clearly superior to touch.

  10. Multimodality and the future of Personal Assistants

    Dahlberg, Stefan


    The purpose of this thesis is twofold. Firstly, as it is essential to appreciate the different modalities involved in Human to Human or Human to Machine communication, the thesis starts with an overview of the basic Human and Machine communication theories before introducing the related Multimodality theory and progressing to present the Personal Assistant Model. Secondly with regard to multimodality specifically, the thesis continues to forecast the evolution paths that Personal Assistan...