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Sample records for analgesia controlada pelo

  1. Considerações sobre analgesia controlada pelo paciente em hospital universitário Consideraciones sobre analgesia controlada por el paciente en hospital universitario Patient controlled analgesia in a university hospital

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    Guilherme Antônio Moreira de Barros

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O rápido progresso obtido nas técnicas cirúrgicas e anestésicas nos últimos anos proporcionou extraordinário aumento das indicações de procedimentos invasivos. Por outro lado, com o envelhecimento da população, o período de recuperação pós-operatória passou a ser motivo de maior preocupação da equipe de saúde. Para tanto, novas técnicas de analgesia foram criadas e desenvolvidas e, dentre elas, destaca-se a Analgesia Controlada pelo Paciente (ACP. Em nosso país, o Serviço de Dor Aguda (SEDA da Disciplina de Terapia Antálgica e Cuidados Paliativos, do Departamento de Anestesiologia da Faculdade de Medicina de Botucatu - UNESP, utiliza há muitos anos esta técnica de analgesia. Com a finalidade de atestar a qualidade do serviço prestado, a pesquisa objetiva verificar a eficácia e segurança do método, assim como identificar e caracterizar a população atendida. MÉTODO: De modo retrospectivo, foram avaliados 679 pacientes tratados pelo SEDA, exclusivamente com o método de ACP, durante três anos. Os pacientes foram incluídos na análise aleatoriamente, sem restrições quanto à idade, ao sexo, ao tipo de cirurgia e considerando-se unicamente a possibilidade de indicação da ACP. Foram estudados os seguintes atributos: sexo, idade, tipo de cirurgia, intensidade da dor, dias de acompanhamento, analgésicos utilizados, vias de administração, ocorrência de efeitos colaterais e complicações da técnica. RESULTADOS: 3,96% dos pacientes submetidos a cirurgias e 1,64% dos internados no período observado foram acompanhados com técnica ACP. A cirurgia torácica foi a mais freqüentemente atendida, com 25% dos pacientes. A morfina foi o medicamento mais utilizado (54,2%, sendo a via peridural a preferencial (49,5%. A escala numérica verbal média foi de 0,8 (0-10. Os efeitos colaterais ocorreram em 22,4% dos doentes tratados. CONCLUSÕES: Os resultados foram considerados excelentes quanto

  2. Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo Analgesia controlada por el paciente con fentanil o sufentanil en el pós-operatorio de reconstrucción de ligamentos de la rodilla: estudio comparativo Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

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    Marcelo Negrão Lutti

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os opióides têm sido utilizados por via peridural associados ou não a anestésicos locais para analgesia pós-operatória de forma contínua e/ou em bolus controlado pelo paciente. O objetivo deste estudo foi comparar a analgesia pós-operatória entre o fentanil e sufentanil em infusão contínua e em bolus por via peridural, em pacientes submetidos à reconstrução de ligamento do joelho. MÉTODO: Participaram do estudo 70 pacientes com idades entre 16 e 47 anos, estado físico ASA I e II, divididos aleatoriamente em dois grupos: Grupo F (fentanil e Grupo S (sufentanil. Todos os pacientes foram submetidos à anestesia peridural com bupivacaína a 0,5% (100 mg com epinefrina 1:200.000 associada a fentanil (100 mg. Ao final da cirurgia, os pacientes receberam fentanil (Grupo F ou sufentanil (Grupo S por via peridural em regime de infusão contínua mais bolus liberados pelo paciente. No Grupo F foi utilizada solução fisiológica (85 ml contendo fentanil 500 µg (10 ml e bupivacaína (5 ml a 0,5%. No Grupo S foi utilizada solução fisiológica (92 ml contendo sufentanil 150 µg (3 ml e bupivacaína (5 ml a 0,5%. Para os dois grupos a bomba de infusão foi programada inicialmente em 5 ml.h-1, com dose de 2 ml em bolus liberado pelo paciente num intervalo de 15 minutos. Foram comparados os seguintes parâmetros: dor, número de bolus acionados, consumo de opióides, bloqueio motor, sedação e efeitos colaterais. RESULTADOS: Não houve diferença entre os grupos quanto à qualidade da analgesia, sendo a maioria de boa qualidade (EAV 0 a 2. Houve diferença quanto ao número de bolus liberados. No Grupo F solicitou mais bolus que o Grupo S. Não houve diferença quanto ao volume total e tempo de infusão total. Não houve bloqueio motor após a instituição da analgesia controlada pelo paciente. A incidência de vômitos e retenção urinária foi maior no Grupo S e quanto à sedação e ao prurido, não houve

  3. Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho Analgesia controlada por el paciente reduce consumo de bupivacaína en bloqueo femoral para manejo de dolor postoperatorio en reconstrucción de ligamento cruzado anterior de rodilla Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

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    Victor A. Contreras-Domínguez

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (BFC é utilizado na analgesia pós-operatória das substituições articulares de quadril e joelho com bom resultado. O objetivo deste estudo foi avaliar a utilidade do BFC, comparando três esquemas de administração de bupivacaína após reconstrução do ligamento cruzado anterior (LCA do joelho por artroscopia. MÉTODO: Estudo prospectivo controlado de 90 pacientes estado físico ASA I e II. Os pacientes foram divididos em três grupos: Grupo 1 (n = 30: 10 mL.h-1 em infusão contínua (IC de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C; Grupo 2 (n = 30: 5 mL.h-1 em IC + 2,5 mL de B + C em PCA a cada 30 min; Grupo 3 (n = 30: 5 mL.h-1 de B + C em PCA cada 30 min. A anestesia foi por via subaracnóidea. A dor pós-operatório foi registrada às 2, 4, 6, 24 e 48 horas após a operação avaliada pela Escala Analógica Visual (VAS. Anotou-se também consumo de bupivacaína e morfina. RESULTADOS: Não foram registradas diferenças nas variáveis demográficas entre ambos os grupos. O VAS pós-operatório entre 2 e 48 horas não mostrou diferenças. O consumo de morfina entre 4 e 48 horas foi similar nos três grupos (p = 0,07. No grupo em que só foi utilizado o modo PCA, o consumo de bupivacaína foi significativamente menor (p JUSTIFICATIVA Y OBJETIVOS: El bloqueo femoral continuo (BFC se utiliza en la analgesia postoperatoria de los reemplazos articulares de cadera y rodilla con buen resultado. El objetivo es evaluar la utilidad del BFC, comparando 3 esquemas de administración de bupivacaína en reconstrucción de ligamento cruzado anterior (LCA de rodilla asistida por artroscopía. MÉTODO: Estudio prospectivo controlado de 90 pacientes estado físico ASA I y II estables. Los pacientes fueron divididos en tres grupos. El Grupo 1 (n = 30: 10 mL.h-1 en infusión continua (IC de bupivacaína 0,125% + clonidina 1µg.mL-1 (B + C; Grupo 2 (n = 30: 5 mL.h-1 en IC + 2,5 mL de B + C en PCA

  4. 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

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    J. M. López-Millán

    2007-08-01

    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.

  5. Comparação de morfina administrada por via intravenosa e via epidural com/sem bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia com a técnica de analgesia controlada pelo paciente Comparación de la morfina administrada por vía intravenosa y vía epidural con /sin bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía con la técnica de analgesia controlada por el paciente Comparison of intravenous morphine, epidural morphine with/without bupivacaine or ropivacaine in postthoracotomy pain management with patient controlled analgesia technique

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    Esra Mercanoğlu

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo randomizado, duplo-cego e prospectivo foi determinar a eficácia e os efeitos colaterais da administração por via intravenosa ou epidural de morfina, bupivacaína ou ropivacaína no tratamento da dor pós-toracotomia. MÉTODOS: Sessenta pacientes submetidos a procedimentos de toracotomia eletiva foram randomicamente alocados em quatro grupos com o uso da técnica de envelopes lacrados. Os grupos MIV, ME, MEB e MER receberam morfina controlada pelo paciente por via intravenosa, e morfina, morfina-bupivacaína e morfina- ropivacaína epidural, respectivamente. Frequência cardíaca, pressão arterial e saturação de oxigênio perioperatórias e dor pós-operatória em repouso e durante a tosse, efeitos colaterais e necessidade de analgésicos de resgate foram registrados aos 30 e 60 minutos e em duas, quatro, seis, 12, 24, 36, 48 e 72 horas. RESULTADOS: A necessidade de sódio diclofenaco durante o estudo foi menor no grupo ME. A área sob a curva de tempo na VAS foi menor no grupo ME em comparação com o Grupo MIV, mas similar aos Grupos MEB e MER. Os escores de dor em repouso foram maiores nos tempos 12, 24, 36 e 48 horas no Grupo MIV em comparação com o Grupo ME. Os escores de dor em repouso foram maiores aos 30 e 60 minutos nos Grupos ME e MIV em comparação com o Grupo MEB. Os escores de dor durante a tosse aos 30 minutos foram maiores no grupo ME em comparação com o Grupo MEB. Não houve diferença entre os Grupos MIV e MER. CONCLUSÕES: Morfina administrada por via epidural foi mais eficaz do que por via intravenosa. A eficácia foi maior no grupo EM no período pós-operatório tardio e no Grupo MEB no período pós-operatório inicial. Concluímos que morfina administrada por via epidural foi a mais eficaz e preferida.JUSTIFICATIVA Y OBJETIVOS: El objetivo de este estudio aleatorio, doble ciego y prospectivo fue determinar la eficacia y los efectos colaterales de la administraci

  6. Qualidade fisiológica de sementes de Eruca sativa L. pelo teste de deterioração controlada Physiological quality of Eruca sativa L. seeds by the test of controlled deterioration

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    Charline Zaratin Alves

    2011-12-01

    Full Text Available A qualidade da semente utilizada no processo de produção agrícola é um dos principais fatores a ser considerado para a implantação da cultura, havendo consenso entre todos os segmentos, sobre a importância do vigor das sementes e da necessidade de avaliá-lo. O presente trabalho teve o objetivo de estudar variações na condução do teste de deterioração controlada, verificando sua eficiência na identificação de diferentes níveis de vigor de sementes de rúcula, cultivar 'Cultivada' e 'Gigante' utilizando-se cinco lotes de sementes para cada um. As sementes foram submetidas à determinação do teor de água e a testes de germinação, primeira contagem de germinação, emergência e, para verificar a eficiência na identificação de diferentes níveis de vigor, foram estudadas variações no teste de deterioração controlada (teor de água de 18, 21 e 24%, a 45°C durante 24 e 48 horas. O experimento foi montado no delineamento inteiramente casualizado e os resultados foram submetidos à análise de variância, sendo que as médias foram comparadas pelo teste de Tukey a 5% de probabilidade. Pelos resultados obtidos no teste de deterioração controlada, observou-se que não houve relação com as avaliações iniciais do potencial fisiológico das sementes, principalmente para o teste de emergência. Concluiu-se que, nas condições estudadas, esse teste não é sensível o suficiente para a avaliação do potencial fisiológico de sementes de rúcula, para ambas as cultivares estudadas.The quality of the seed used in the process of agricultural production is one of the main factors to be considered for the implantation of the culture, having consensus between all the segments, on the importance of the vigor of the seeds and the necessity to evaluate it. This research had the purpose of studying proccedings for controlled deterioration test, to verify their sensitivity for identifying different vigor levels of arugula seed, cv

  7. Analgesia adjuvante e alternativa

    OpenAIRE

    Vale Nilton Bezerra do

    2006-01-01

    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...

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

    OpenAIRE

    Nilton Bezerra do Vale

    2006-01-01

    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...

  9. Analgesia adjuvante e alternativa

    Directory of Open Access Journals (Sweden)

    Vale Nilton Bezerra do

    2006-01-01

    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.

  10. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    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...

  11. Analgesia postoperatoria en cirugía mayor: ¿es hora de cambiar nuestros protocolos?

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    N. Esteve Pérez

    2009-05-01

    Full Text Available La analgesia postoperatoria es uno de los componentes básicos en la recuperación funcional tras una intervención quirúrgica. No obstante, es difícil aislar los efectos de la analgesia postoperatoria de otros aspectos relacionados con la técnica quirúrgica, la práctica clínica, el tipo de seguimiento analgésico o los factores organizativos del equipo quirúrgico. La introducción de la laparoscopia, la toracoscopia y las técnicas quirúrgicas mínimamente invasivas está modificando los protocolos analgésicos clásicos en la cirugía compleja. La analgesia intravenosa controlada por el paciente e incluso los opioides por vía oral están desplazando a la analgesia epidural en este tipo de técnicas. La evaluación del riesgo/beneficio para la selección de cada tipo de analgesia postoperatoria dependerá de la severidad del dolor dinámico y de los potenciales efectos secundarios de las técnicas y los fármacos analgésicos. Es difícil demostrar el impacto de la analgesia postoperatoria en grandes resultados quirúrgicos como la mortalidad, la morbilidad o la estancia media, que dependen de factores múltiples y heterogéneos. El efecto del tipo de analgesia en el proceso quirúrgico debería investigarse sobre otros resultados orientados al paciente, como la calidad analgésica, los efectos adversos o el bienestar postoperatorio. Otras áreas en las que se plantea el posible impacto de la analgesia postoperatoria son la recurrencia oncológica y el dolor crónico postoperatorio.

  12. Bloqueio dos nervos ilioinguinal e ílio-hipogástrico com dexcetoprofeno intravenoso melhora a analgesia após histerectomia abdominal

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    Evren Yucel

    2013-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: O objetivo deste estudo foi avaliar os efeitos da aplicação intravenosa(IV de dexcetoprofeno trometamol em bloqueio dos nervos ilioinguinal e ílio-hipogástrico na qualidade analgésica e no consumo de morfina após histerectomia abdominal total. MÉTODO: Estudo clínico controlado e randomizado conduzido com 61 pacientes. O estudo foi feito em sala de operação, sala de recuperação pós-anestésica e ambulatório. Os 61 pacientes foram randomicamente alocados em três grupos: grupo controle (Grupo C, grupo bloqueio (Grupo B e grupo bloqueio com dexcetoprofeno (Grupo BD. Antes da incisão cirúrgica feita após a indução da anestesia, fizemos o bloqueio dos nervos ilioinguinal e ilio-hipogástrico (Grupo C recebeu solução salina e grupos B e BD receberam levobupivacaína. Em contraste com os grupos C e B, o Grupo BD recebeu dexcetoprofeno. Administramos morfina a todos os pacientes para analgesia, com o uso do método de analgesia controlada pelo paciente (ACP durante o pós-operatório de 24 horas. Registramos os escores para dor pela escala visual analógica (EVA, os índices de satisfação, o consumo de morfina e os efeitos colaterais durante o pós-operatório de 24 horas. RESULTADOS: Os escores EVA do Grupo BD foram menores do que os dos grupos C e B no pós-operatório (p < 0,05 nos intervalos de 1, 2, 6 e 12 horas. Os escores EVA do Grupo C foram maiores do que os do Grupo B nas primeiras 2 horas de pós-operatório. O tempo até a primeira demanda de ACP foi mais longo, os valores de consumo de morfina mais baixos e os índices de satisfação maiores no Grupo BD do que nos outros dois grupos (p < 0,05. CONCLUSÃO: O bloqueio dos nervos ilioinguinal e ílio-hipogástrico com dexcetoprofeno IV aumenta a satisfação do paciente e diminui o consumo de opioides e sugere que dexcetoprofeno trometamol é um analgésico anti-inflamatório não esteroide eficaz em analgesia pós-operatória.

  13. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    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. Anuncian primera produccion controlada de anti-atomos frios

    CERN Multimedia

    2002-01-01

    "Un equipo internacional que trabaja con el desacelerador de antiprotones del CERN, en Ginebra, ha conseguido la primera produccion controlada de miles de atomos de hidrogeno de baja energia, lo que facilitara en el futuro los analisis de precision en varias disciplinas cientificas" (1 page).

  15. Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho Bloqueo 3 en 1 prolongado versus analgesia sistemica en el tratamiento del dolor postoperatorio después de la reconstrucción del ligamento cruzado anterior de la rodilla Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

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    Víctor A. Contreras-Domínguez

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (3-em-1 é usado para a analgesia pós-operatória de artroplastia de quadril e joelho com bons resultados, apresentando vantagens sobre outras técnicas de analgesia locorregional ou sistêmica e com baixa incidência de complicações. O objetivo deste estudo foi avaliar clinicamente a utilidade do bloqueio femoral contínuo em comparação com a analgesia por via venosa na reconstrução do ligamento cruzado anterior. MÉTODO: Foi realizado um estudo prospectivo, controlado, com 60 pacientes com estado físico ASA I. Os paciente foram divididos em dois grupos: Grupo 1 (n = 30: bloqueio femoral contínuo com infusão de bupivacaína e clonidina; Grupo 2 (n = 30: infusão por via venosa de cetoprofeno. A intervenção cirúrgica foi realizada sob raquianestesia e sedação. O tratamento da dor pós-operatória foi feito com analgesia controlada pelo paciente (PCA usando morfina. A dor pós-operatória foi registrada 2, 4, 6, 24 e 36 horas após a intervenção cirúrgica usando a Escala Visual Analógica (VAS. O consumo de morfina, a satisfação dos pacientes e as complicações também foram registradas. RESULTADOS: No Grupo 1, o VAS pós-operatório entre 4 e 48 horas após a intervenção cirúrgica foi de 21 mm ± 2 e no Grupo 2 foi de 45 mm ± 4 (p JUSTIFICATIVA Y OBJETIVOS: El bloqueo femoral continuo (tres-en-uno se usa para la analgesia postoperatoria de artroplastia de cadera y rodilla con buenos resultados, presentando ventajas sobre otras técnicas de analgesia loco regional o sistemica y con baja incidencia de complicaciones. El objetivo de este estudio fue el de evaluar clínicamente la utilidad del bloqueo femoral continuo en comparación con la analgesia intravenosa en la reconstrucción del ligamento cruzado anterior. MÉTODOS: Se realizó un estudio prospectivo controlado con 60 pacientes de estado físico ASA I. Los pacientes fueron divididos en dos grupos: Grupo 1 (n

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

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    Wesam Farid Mousa

    2012-01-01

    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 pós-toracotomia com associação de morfina por via peridural e venosa Analgesia pós-toracotomia con asociación de morfina por vía peridural y venosa Comparison of intravenous and epidural morphine analgesia after thoracotomy

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2002-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Analgesia após cirurgia de tórax é feita por diferentes métodos. O objetivo do estudo foi avaliar a analgesia pós-operatória com associação de morfina por via venosa e peridural, comparada ao uso por via isolada. MÉTODO: Foram estudados 20 pacientes submetidos à cirurgia de tórax, ambos os sexos, estado físico ASA I a III. Foi feita medicação pré-anestésica com midazolam por via venosa (3 a 3,5 mg na SO. A monitorização constou de ECG contínuo, pressão arterial invasiva, oximetria de pulso, capnografia, PVC, diurese e temperatura. Primeiramente foi realizada anestesia peridural contínua, T7-T8 com 10 ml de bupivacaína a 0,25% e, em seguida, indução com fentanil (5 µg.kg-1, etomidato (0,2 a 0,3 mg.kg-1 e succinilcolina (1 mg.kg-1. Foi feita IOT com tubo de duplo lume, complementação com pancurônio (0,08 a 0,1 mg.kg-1 e ventilação controlada mecânica. Os pacientes foram então distribuídos aleatoriamente em três grupos. Ao Grupo I, administrou-se pelo cateter peridural, 2 mg de morfina 0,1% na indução da anestesia (M1, após 12 horas (M2 e 24 horas (M3 do final da cirurgia, ao Grupo II, morfina por via venosa em bomba de infusão (15 µg.kg.h-1 precedida de bolus de 50 µg.kg-1, durante 30 horas e ao Grupo III, morfina por via peridural na dose de 0,5 mg em M1, M2 e M3, associada com morfina venosa em bomba de infusão (8 µg.kg.h-1 precedida de bolus de 25 µg.kg-1, por 30 horas. Análise de gases arteriais, freqüências cardíaca e respiratória, presença de prurido, náuseas, vômitos e analgesia pós-operatória foram avaliados a cada 6 horas, até um total de 30 horas do pós-operatório. A analgesia foi avaliada por escala de graduação numérica (EGN de 0 a 10. RESULTADOS: A EGN apresentou redução no grupo I apenas no momento M2 não ocorrendo nos demais intervalos. Nos grupos II e III ocorreu redução da dor a partir de 18 horas em relação aos valores iniciais e em rela

  18. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pela via posterior promove analgesia pós-operatória efetiva na artroplastia total do quadril. Ropivacaína e bupivacaína não apresentaram qualquer diferença na eficácia analgésica em diferentes bloqueios de nervos periféricos. O objetivo deste estudo foi comparar a eficácia da analgesia pós-operatória resultante da administração em dose única da bupivacaína a 0,5% ou da ropivacaína a 0,5% no bloqueio do plexo lombar pela via posterior na artroplastia total do quadril. MÉTODO: Trinta e sete pacientes foram alocados aleatoriamente em dois grupos, segundo o anestésico local utilizado no bloqueio: Grupo B - bupivacaína a 0,5% com epinefrina 1:200.000 ou Grupo R - ropivacaína a 0,5%. Durante o período pós-operatório, os escores de dor e o consumo de morfina na analgesia controlada pelo paciente foram comparados entre os grupos. O sangramento durante a operação e a incidência de efeitos adversos e de complicações também foram comparados. RESULTADOS: Apesar dos escores de dor terem sido menores no Grupo R 8, 12 e 24 horas após o bloqueio, essas diferenças não foram clinicamente significativas. Regressão linear múltipla não identificou o anestésico local como variável independente. Não houve diferença no consumo de morfina, no sangramento intraoperatório e na incidência de complicações e efeitos adversos entre os dois grupos. CONCLUSÕES: A bupivacaína a 0,5% e a ropivacaína a 0,5% produziram alívio eficaz e prolongado da dor pós-operatória após artroplastia total do quadril, sem diferença clínica, quando doses equivalentes foram administradas no bloqueio do plexo lombar pela via posterior.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por la vía posterior, genera una analgesia postoperatoria efectiva en la artroplastia total de la cadera. La ropivacaína y la bupivacaína no arrojaron ninguna diferencia en la eficacia analgésica en

  19. Remifentanil as analgesia for labour pain

    OpenAIRE

    Tveit, Tor Oddbjørn

    2013-01-01

    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 ...

  20. Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

    Directory of Open Access Journals (Sweden)

    Marilda Onghero Taffarel

    2009-12-01

    Full Text Available A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se com este trabalho fazer uma breve revisão sobre as aplicações clínicas e os efeitos fisiológicos da acupuntura nos mecanismos da dor, bem como demonstrar os principais pontos de acupuntura utilizados para analgesia em animais. A pesquisa foi realizada em bases de dados eletrônicas por palavra-chave, durante o período de março a dezembro de 2008.Pain is a protective response of the body to harmful stimulus, which results in undesirable effects if not controlled. Analgesia can be achieved with the use of different types of drugs. However, these drugs can cause adverse effects according to species and patient physical condition. Acupuncture has been proved to be an effective analgesic adjuvant, by the capacity to decrease the amount of drug used for pain control, rarely contra-indicated. The aim of this paper was to review the physiological effects of acupuncture on pain mechanisms, and demonstrate the main acupoints used for animal analgesia. The search was done in electronic search database using key words, in 2008.

  1. Atmosfera controlada associada ao 1-metilciclopropeno na preservação da qualidade de kiwi ‘tewi’

    Directory of Open Access Journals (Sweden)

    Camila Pegoraro

    2016-01-01

    Full Text Available Resumo O objetivo deste trabalho foi determinar os efeitos de diferentes tecnologias de armazenamento na qualidade físico-química de kiwis da cultivar Tewi. Após a colheita, parte dos frutos foi submetida ao tratamento com 1-metilciclopropeno (1-MCP e, posteriormente, frutos tratados e não tratados foram submetidos a diferentes condições de armazenamento, conforme segue: armazenamento em temperatura ambiente (20 °C ± 0,5 °C durante 12 dias; armazenamento refrigerado (0°C ± 0,5°C com ou sem controle da atmosfera (3 KPa O2 e 5 KPa CO2, e com ou sem absorção de etileno durante dois e quatro meses. Foram avaliadas a firmeza de polpa, o teor de sólidos solúveis e a acidez titulável. Verificou-se que, independentemente da tecnologia de conservação, houve uma diminuição na firmeza de polpa já aos dois meses de armazenamento, sendo a condição atmosfera controlada associada ao uso do 1-MCP a mais eficaz na retenção desse atributo. Frutos mantidos em temperatura ambiente apresentaram relação direta entre a redução da firmeza de polpa e o aumento do índice de sólidos solúveis; no entanto, após o armazenamento, essa relação nem sempre ocorreu. A maior acidez titulável foi verificada em frutos que receberam 1-MCP. Kiwis ‘Tewi’ apresentam bom potencial de conservação, podendo permanecer armazenados por até quatro meses em atmosfera controlada associada ao controle do etileno pelo uso de 1-MCP ou por absorção do etileno.

  2. Epidural analgesia for cardiac surgery

    NARCIS (Netherlands)

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

    2013-01-01

    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

  3. Conservação pós-colheita do milho verde minimamente processado sob atmosfera controlada e refrigeração

    Directory of Open Access Journals (Sweden)

    Alexandra Mara Goulart Nunes Mamede

    2015-04-01

    Full Text Available O consumo de espigas de milho verde com endosperma normal é tradicional, no Brasil, e a sua comercialização in natura é cada vez maior no mercado de produtos minimamente processados, mostrando a necessidade de mais estudos a respeito de sua vida útil. O objetivo deste trabalho foi avaliar a influência de duas atmosferas controladas (2% O2 + 8% CO2, 4% O2 + 8% CO2 e atmosfera ambiente, na qualidade de milho verde, do tipo normal Embrapa HT1, minimamente processado, durante 12 dias de armazenamento, a 5 °C. As atmosferas controladas foram eficientes em reduzir a perda de massa das espigas de milho, apresentando também menores valores de acidez titulável, o que indica menor atividade respiratória. Os sólidos solúveis, os carotenoides totais, a zeaxantina, a firmeza e os teores de glicose, frutose e sacarose foram influenciados somente pelo tempo de armazenamento, com maiores teores de açúcares redutores em relação aos da sacarose durante todo o armazenamento. O valor L* apresentou decréscimo até o oitavo dia de armazenamento, em todas as atmosferas estudadas, com pequeno aumento no controle até o 12º dia. Todas as amostras analisadas, independentemente das atmosferas de conservação, encontravam-se dentro dos limites microbiológicos aceitáveis e seguros para consumo.

  4. [Perioperative analgesia in adults : The concept of balanced analgesia.].

    Science.gov (United States)

    Jage, J

    1993-09-01

    The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. Recovery and physical mobilization are improved as the result of adequate treatment. Results obtained in recent studies have demonstrated that primary adaptive hyperalgesia in the peripheral nociceptive area may develop into secondary maladaptive hypersensibility with a high degree of nociceptive excitability and pain. Chronic pain can develop following acute alterations. Increasing nociceptive activity of primary afferents induces alterations in the dorsal horn of the spinal cord. These alterations imply an increase in the excitability of nociceptive neurons, which has been described as neuronal plasticity. Clinical results have demonstrated prevention or delay of acute postoperative pain after injection of local anaesthetics, analgesic premedication or epidural injection of opioids just before the start of surgery. Continuous perioperative spinal analgesia has contributed significantly to the prevention of phantom limb pain in patients undergoing amputation of extremities. The development of pain memory may be prevented as a result of effective acute pain treatment. Several changes to the terminology of acute pain treatment for animal and clinical studies have recently been proposed, including such new terms as preemptive analgesia and pain prevention, which indicate new strategies in the treatment of postoperative pain. The concept of balanced analgesia refers to a strategy for the improvement of analgesic efficacy as a result of a combination of drugs with different local actions on nociception. The combination of

  5. Epidural labour analgesia using Bupivacaine and Clonidine

    OpenAIRE

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

    2011-01-01

    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...

  6. Sedation and Analgesia in Interventional Radiology

    OpenAIRE

    Tuite, Catherine; Rosenberg, Eric J.

    2005-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Tarek AbdElBarr

    2014-07-01

    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.

  8. QUALIDADE DE PERAS ‘ROCHA’ ARMAZENADAS EM ATMOSFERA CONTROLADA

    Directory of Open Access Journals (Sweden)

    MARIUCCIA SCHLICHTING DE MARTIN

    2015-03-01

    Full Text Available RESUMO O objetivo deste trabalho foi avaliar o efeito de diferentes condições de atmosfera controlada (AC e da indução de perda de massa (IPM sobre a qualidade de peras ‘Rocha’. Frutos provenientes do município de São Joaquim-SC, foram armazenados por oito meses e quinze dias a -0,5±0,1 ºC e UR de 96±1%. Os tratamentos foram constituídos em armazenamento refrigerado (AR; 21,0 kPa de O2 + <0,03 kPa de CO2, bem como de cinco condições de AC: 1,0 kPa de O2 + <0,03 kPa de CO2; 2,0 kPa de O2 + 1,0 kPa de CO2; 1,0 kPa de O2 + 1,0 kPa de CO2; 1,0 kPa de O2 + 2,0 kPa de CO2; e 1 kPa de O2 + 2,0 kPa de CO2 + IPM de 2,6%. O AR propiciou frutos com casca mais amarela, menor teor de sólidos solúveis, menor acidez titulável e baixa aceitação nos testes sensoriais para os atributos de textura e equilíbrio doçura/acidez. Os frutos mantidos em AR e em AC, com pressão parcial de CO2 de <0,03 kPa, apresentaram maior firmeza de polpa e de força para penetração da polpa após sete dias de exposição dos frutos em condições ambiente, não desenvolvendo textura amanteigada, própria para o consumo. Não houve incidência de escurecimento de polpa em nenhuma das condições avaliadas. A IPM de 2,6% não apresentou efeito na qualidade dos frutos. As condições de AC de 1,0 kPa de O2 + 1,0 kPa de CO2 e 1 kPa de O2 + 2,0 kPa de CO2 proporcionam melhor manutenção da qualidade de peras ‘Rocha’, permitindo o amadurecimento normal dos frutos após o armazenamento prolongado.

  9. Evaluación de formulaciones de liberación controlada del herbicida Flufenacet

    OpenAIRE

    Gómez-Pantoja Cabezas, María Eulalia; López Fernández, E.; Florido Fernández, María del Carmen; Morillo, E.; Undabeytia, T.

    2015-01-01

    El objetivo del presente trabajo fue comprobar la efectividad de las formulaciones de liberación controlada (FLCs) del herbicida Flufenacet (FLF) previamente elaboradas. Para ello se usaron las formulaciones FLF/ET15 y FLF/B048 que contenían 7,98% y 17,7% de ingrediente activo (i.a.) respectivamente. La liberación “in vitro” confirmó un perfil de liberación controlada para ambas formulaciones frente a la formulación comercial (FC) Tiara 60®. El herbicida FLF presentó alta adsorción en suelos ...

  10. Esteira com velocidade controlada para captação da marcha Treadmill with controlled speed for recording gait

    Directory of Open Access Journals (Sweden)

    Vanessa Vilela Monte-Raso

    2010-01-01

    Full Text Available Métodos histológicos e eletrofisiológicos de avaliação da regeneração dos nervos periféricos não provêem dados sobre o real estado funcional do membro interessado, mesmo em condições experimentais controladas. Alguns métodos de avaliação funcional têm sido propostos, mas a correlação entre seus resultados e aqueles dos métodos histológicos e eletrofisiológicos ainda não está perfeitamente estabelecida, o que demanda maiores investigações. Estas, por outro lado, necessitam do aprimoramento dos métodos de captação, armazenamento e processamento dos dados obtidos. Neste trabalho foi desenvolvido uma esteira para caminhada de animais com velocidade controlada para captação das pegadas de ratos submetidos a diferentes tipos de lesão dos nervos ciático, peroneiro e tibial, obtidas numa trilha de marcha captada por uma webcam acoplada a esteira e a um microcomputador capaz de armazenar as marchas filmadas para posteriormente serem digitalizadas para avaliação funcional. A esteira desenvolvida possibilita a captação e filmagem das marchas tendo sido testado em estudos experimentais em andamento sobre lesões do nervo ciático do rato, submetido a diferentes formas de tratamento. Também permite ao pesquisador a captação da marcha com velocidade contínua controlada e pré-estabelecida pelo pesquisador anulando algumas variáveis que possam prejudicar os resultados da pesquisa, além de permitir a visualização imediata da marcha.Histological and electrophysiological methods for evaluation of peripheral nerve regeneration do not faithfully reproduce the functional index of limbs, even in controlled experimental conditions. Some methods of functional evaluation have been proposed, but their correlation to histological and electrophysiological data is not completely established, requiring more investigations with improvement of collection, management and processing of obtained data. In this study we developed a

  11. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    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.

  12. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention. PMID:677506

  13. [Pneumoencephalotomography under diaz-analgesia and narco-analgesia].

    Science.gov (United States)

    Bergeron, J L; Renou, A M; Boulard, G; Vernhiet, J; Nicod, J

    1978-01-01

    The authors reported 92 observations of anesthesia for gaseous encephalotomography interest the adult. The contrast produce is air. 49 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, pancuronium bromide N2O to 60 p. 100. 25 under diazanalgesia and myoresolution. Diazepam, +Fentanyl, succinylcholine, N2O to 60 p. 100. 18 under narco-analgesia and myoresolution. +Fentyl, pancuronium bromide N2O to 60 p. 100. The conditions of the study are described in the first part. The results and their analysis permit the appreciation of: - the patient confort, the quality of the examination; -the respect of the hemodynamics for this examination, reputed to be "difficult"; -the immediatly noticeable diminution of side effects; -the absence of side effects; -the justification and interesting of the control ventilation; -the quality of waking up. In the conclusion the authors underline the interest of their different techniques and the possibility of using them in operations in sitting position in neurosurgery, and all important chirurgical intervention.

  14. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    -structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings...... 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 College of Midwives. Published...

  15. Estudo comparativo dos bloqueios intercostal e interpleural para analgesia pós-operatória em colecistectomias abertas Estudio comparativo de los bloqueos intercostal e interpleural para analgesia pós-operatoria en colecistectomias abiertas Comparative study of intercostal and interpleural block for post-cholecystectomy analgesia

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia no pós-operatório é desejada pelos pacientes e tem sido praticada pela maioria dos anestesiologistas. Além dos opióides, os anestésicos locais têm sido utilizados nos bloqueios periféricos e centrais para se obter a analgesia pós-operatória. O objetivo deste estudo foi comparar duas técnicas de bloqueio dos nervos intercostais para analgesia pós-operatória em colecistectomias abertas. MÉTODO: Sessenta pacientes foram submetidos a colecistectomias abertas com incisão subcostal e receberam bloqueio intercostal (Grupo IC, n=30 ou bloqueio interpleural (Grupo IP, n=30, ambos com 100 mg de bupivacaína a 0,5% com adrenalina, para analgesia pós-operatória. Foram avaliados os tempos de analgesia e as queixas relatadas pelos pacientes. RESULTADOS: A qualidade da analgesia foi considerada boa para ambas as técnicas. A duração média de analgesia foi de 505 minutos no grupo IP e 620 minutos no grupo IC, não havendo diferença estatística entre eles. Náuseas, vômitos e dor abdominal leve foram as queixas pós-operatórias mais freqüentes. Não se constatou qualquer complicação pós-operatória associada exclusivamente aos bloqueios, assim como não foi evidenciado nenhum caso de pneumotórax. CONCLUSÕES: Concluiu-se que as técnicas promoveram analgesia satisfatória após colecistectomia, sendo que o bloqueio interpleural apresentou maior facilidade de execução.JUSTIFICATIVA Y OBJETIVOS: La analgesia en el pós-operatorio es deseada por los pacientes y ha sido practicada por la mayoría de los anestesiologistas. Además de los opioides, los anestésicos locales han sido utilizados en los bloqueos periféricos y centrales para obtenerse la analgesia pós-operatoria. El objetivo de este estudio fue comparar dos técnicas de bloqueo de los nervios intercostales para analgesia pós-operatoria en colecistectomias abiertas. MÉTODO: Sesenta pacientes fueron sometidos a colecistectomias

  16. Intranasal sufentanil/ketamine analgesia in children

    DEFF Research Database (Denmark)

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

    2014-01-01

    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.......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....

  17. Analgesia and Sedation After Pediatric Cardiac Surgery

    OpenAIRE

    2010-01-01

    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...

  18. Analgesia pós-operatória Postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Betina Sílvia Beozzo Bassanezi

    2006-04-01

    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

  19. Armazenamento sob atmosfera controlada de tomates com injúria interna de impacto

    Directory of Open Access Journals (Sweden)

    Moretti Celso Luiz

    2002-01-01

    Full Text Available A injúria interna de impacto causa redução significativa da qualidade de frutos de tomate. O presente trabalho teve como objetivo avaliar a utilização do armazenamento sob atmosfera controlada na redução do desenvolvimento de uma desordem de amadurecimento conhecida como injúria interna de impacto. Tomates (Lycopersicon esculentum Mill, cv. Solimar, foram colhidos no estádio de amadurecimento verde-maduro e tratados com etileno, por 12 horas, a 20degreesC. Ao atingirem o estádio verde-rosado, sofreram uma queda de 40 cm de altura sobre uma superfície plana, lisa e maciça. Metade dos frutos foi então armazenada sobre atmosfera controlada (3% O2; 4% CO2; balanço com N2 por 8 dias a 20degreesC e 85-95% de umidade relativa, e então foram transferidos para atmosfera ambiente até completamente maduros. A outra metade dos frutos foi mantida continuamente em atmosfera ambiente à mesma temperatura e umidade relativa. Quando estavam completamente maduros, os frutos que sofreram injúria mecânica, armazenados sob atmosfera controlada e sob atmosfera ambiente, desenvolveram sintomas de injúria interna de impacto no tecido locular. O armazenamento sob atmosfera controlada não produziu efeitos significativos no conteúdo de vitamina C total e carotenóides totais para o pericarpo e o tecido locular injuriados. Entretanto, o tecido locular injuriado do tratamento armazenado sob atmosfera controlada possuía acidez titulável 15% superior (ao redor de 162 meq ácido cítrico. kg-1 do que o tratamento sob atmosfera ambiente (ao redor de 140 meq ácido cítrico. kg-1 e era similar ao tratamento não injuriado, armazenado em atmosfera ambiente (ao redor de 174 meq ácido cítrico. kg-1. O tecido pericárpico da região injuriada possuía atividade da poligalacturonase similar para os tratamentos armazenados sob ar ou sob atmosfera controlada. O extravasamento de eletrólitos do pericarpo injuriado foi similar para os tratamentos sob atmosfera

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

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    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

  1. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    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 controv...

  2. Involvement of connexin 43 in acupuncture analgesia

    Institute of Scientific and Technical Information of China (English)

    HUANG Guang-ying; ZHENG Cui-hong; YU Wei-chang; TIAN Dai-shi; WANG Wei

    2009-01-01

    Background Connexin 43 (Cx43) is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli (ST36) acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia. Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

  3. Pain analgesia among adolescent self-injurers.

    Science.gov (United States)

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

    2014-12-30

    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

  4. Formulações de anestésicos locais de liberação controlada: aplicações terapêuticas Formulaciones de anestésicos locales de liberación controlada: aplicaciones terapéuticas Drug-delivery systems for local anesthetics: therapeutic applications

    Directory of Open Access Journals (Sweden)

    Daniele Ribeiro de Araújo

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O desenvolvimento de sistemas de liberação controlada tem sido alvo de pesquisas há pelo menos quatro décadas. Desde que foi sugerida sua aplicação na indústria farmacêutica, muitos resultados foram obtidos, especialmente na manipulação molecular de carreadores e no estudo de suas interações com as drogas encapsuladas. Esses novos carreadores têm a vantagem de contornar propriedades físico-químicas limitantes (como a solubilidade aquosa ou em membranas das drogas encapsuladas, melhorando assim a farmacodinâmica (potencialização do efeito terapêutico, farmacocinética (controle da absorção e distribuição tecidual e os efeitos toxicológicos (redução da toxicidade local e sistêmica das mesmas. Entre os principais carreadores, destacam-se os lipossomas e as ciclodextrinas, que vêm trazendo inúmeras vantagens no desenvolvimento de formulações para liberação controlada de anestésicos locais. Este trabalho de revisão objetiva descrever a interação de anestésicos locais com lipossomas ou ciclodextrinas, o desenvolvimento das pesquisas básica e clínica nessa área, além da aplicabilidade terapêutica dessas formulações. CONTEÚDO: Lipossomas têm a capacidade de veicular drogas em órgãos-alvo, disponibilizando apenas uma fração - liberação controlada - para o sítio de ação. Já as ciclodextrinas alteram a intensidade e a duração do efeitos das drogas através da baixa absorção sistêmica do complexo. Pesquisas básicas e clínicas apontam como vantagens do uso de anestésicos locais encapsulados em lipossomas ou complexados com ciclodextrinas a liberação lenta da droga que prolonga a duração da anestesia e reduz a toxicidade para os sistemas cardiovascular e nervoso central. CONCLUSÕES: Embora várias pesquisas ainda estejam em andamento, os sistemas de liberação controlada de anestésicos locais indicam uma nova direção no desenvolvimento de formulações anest

  5. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  6. Potentiation of morphine analgesia by caffeine.

    Science.gov (United States)

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

    1985-04-01

    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

  7. Conseqüência da umidade relativa durante o armazenamento refrigerado e em atmosfera controlada na qualidade da maçã 'Gala'

    OpenAIRE

    Brackmann Auri; Pinto Josuel Alfredo Vilela; Steffens Cristiano André; Guarienti Affonso José Wietzke; Giehl Ricardo Fabiano Hettwer; Sestari Ivan

    2005-01-01

    O objetivo do presente trabalho foi avaliar o efeito da umidade relativa no armazenamento refrigerado e em atmosfera controlada sobre a qualidade de maçãs 'Gala' colhidas tardiamente. Os tratamentos foram armazenamento refrigerado + alta umidade relativa (96%), armazenamento refrigerado + baixa umidade relativa (90%), atmosfera controlada + alta umidade relativa (96%) e atmosfera controlada + baixa umidade relativa (90%). Os frutos de todos os tratamentos foram mantidos a 0,5degreesC e a cond...

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

    OpenAIRE

    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

    2015-01-01

    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....

  9. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    : 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...

  10. Deformabilidad de las arcillas expansivas bajo succión controlada

    OpenAIRE

    Pousada Presa, Erundino

    1982-01-01

    Esta investigación trata del estudio de los cambios de volumen de las arcillas expansivas debidos a modificaciones de humedad e a variaciones de presiones en el suelo, mediante ensayos edométricos con succión controlada. En el estudio experimental se consideran distintas condiciones del estado inicial del suelo, diferentes trayectorias de tensión y de humectación, así como la repetición de ciclos de humedad-sequedad. El objetivo principal de este trabajo es conocer mejor el desarrollo y evolu...

  11. Aplicació domòtica controlada per WAP, WEB i SMS

    OpenAIRE

    Pujalte Vidal, Santiago

    2005-01-01

    Aquest document explica el desenvolupament i funcionament d’una aplicació Domòtica controlada a través de WAP, WEB i SMS. Amb aquesta aplicació es poden controlar tant dispositius que solament tinguin dos estats (calefacció, neveres, fluorescents…), com dispositius que tinguin diversos estats (llums d’incandescència, motors, calentadors…). A més del control remot dels dispositius aquesta aplicació té altres funcionalitats, com alarma per SMS de canvis en els dispositius o si...

  12. Armazenamento sob atmosfera controlada de tomates com injúria interna de impacto

    OpenAIRE

    Moretti Celso Luiz; Sargent Steven A.; Huber Donald J.; Puschmann Rolf

    2002-01-01

    A injúria interna de impacto causa redução significativa da qualidade de frutos de tomate. O presente trabalho teve como objetivo avaliar a utilização do armazenamento sob atmosfera controlada na redução do desenvolvimento de uma desordem de amadurecimento conhecida como injúria interna de impacto. Tomates (Lycopersicon esculentum Mill), cv. Solimar, foram colhidos no estádio de amadurecimento verde-maduro e tratados com etileno, por 12 horas, a 20degreesC. Ao atingirem o estádio verde-rosado...

  13. Condições de atmosfera controlada para a maçã ?Pink Lady?

    Directory of Open Access Journals (Sweden)

    Brackmann Auri

    2005-01-01

    Full Text Available O objetivo do presente trabalho foi avaliar o efeito de diferentes temperaturas e pressões parciais de O2 e CO2 sobre a manutenção da qualidade da maçã (Malus domestica Borkh. cultivar Pink Lady durante o armazenamento em atmosfera controlada. Os tratamentos avaliados foram 1,5kPa de O2 + 1,0kPa de CO2 na temperatura de -0,5degreesC, e 1,5kPa de O2 + 1,0kPa de CO2; 1,5kPa de O2 + 2,0kPa de CO2; 1,0kPa de O2 + 1,0kPa de CO2; 1,0kPa de O2 + <0,5kPa de CO2; armazenamento refrigerado (20,8kPa de O2 + <0,5kPa de CO2 na temperatura de +0,5degreesC. As avaliações foram realizadas após nove meses de armazenamento, seguidos de sete dias de exposição dos frutos a 20degreesC. Os frutos mantidos em atmosfera controlada apresentaram menor ocorrência de podridões, maior firmeza de polpa e maior teor de sólidos solúveis totais, em comparação com os frutos conservados em armazenamento refrigerado. As melhores condições de atmosfera controlada para conservação da qualidade da maçã ?Pink Lady? foram 1,5kPa de O2 + 1,0kPa de CO2 na temperatura de -0,5degreesC, e 1,5kPa de O2 + 1,0kPa de CO2; 1,5kPa de O2 + 2,0kPa de CO2 na temperatura de +0,5degreesC, já as pressões parciais 1,0kPa de O2 + 1,0kPa de CO2 e 1,0kPa de O2 + <0,5kPa de CO2 apresentaram maiores valores de podridão e degenerescência senescente, respectivamente. A atmosfera controlada, com exceção da atmosfera refrigerada, mantém conservada a qualidade da maçã ?Pink Lady?.

  14. À margem: escrita de exceção em cartas controladas pelo estado = On the margins: writing of exception in letters controlled by the state

    Directory of Open Access Journals (Sweden)

    Vera Lucia Silva

    2013-04-01

    Full Text Available O objetivo deste estudo é apresentar como a linguagem se materializa, enquanto um ritual que falha, no texto-carta produzido por pessoas em situação de segregação. Os conceitos teóricos de Michel Pêcheux, Eni Orlandi e outros autores serão norteadores da reflexão sobre essa escrita direcionada por uma legislação que impede, mas também autoriza o Estado a acionar seu olhar panóptico sobre esses sujeitos que, na posição de presidiários, tem o ‘direito’ de manter seu vínculo social com a sociedade extramuro. A evidência de uma língua transparente e sentido literal se desfazem diante da ilusão de completude que o Estado produz no modo como esse sujeito pode e deve escrever sua correspondência, mediante uma legislação que o norteia. Mas as falhas vão permeando esse ritual de escrita e o desejo do ‘escape’ produzem outros sentidos em um espaço que tenta controlar os movimentos desses agentes de violência que se materializam no desejo de transpor os muros e ir ao encontro do seu sonho de liberdade, via correio.This study aimed at presenting how language materialize, as a ritual that fails, in the context text-letter produced by people in a segregating situation. Michel Pêcheux’s, Eni Orlandi’s and other authors’ theoretical concepts lead the reflection on this writing directed by legislation that impedes, but that also authorizes the State to set its panoptic look on these subjects, who, being prisoners, have the ‘right’ to keep their social bond to the society outside. The evidence of a transparent language and literal sense vanish facing the completeness illusion that the State produces on the way that this subject can and must write their letters, respecting the legislation surrounding them. However, failures permeate this writing ritual and the desire of ‘escaping’ produce other meanings at a place that attempts to control the moves of these violence agents that materialize in the desire of transposing the gates and meet their dreams of freedom, by mail.

  15. Metodología para el control microbiológico de áreas controladas

    Directory of Open Access Journals (Sweden)

    Dailín Cobos Valdes

    2009-01-01

    Full Text Available Se implementa una metodología para el control microbiológico de las áreas controladas del Centro de Inmunología y Biopreparados, reportando diferencias significativas en los resultados de la carga microbiológica de las áreas, su influencia en la disminución del porcentaje de rechazo de productos críticos y su repercusión en los resultados contables de nuestra institución. Como parte de la misma se desarrollan programas de limpieza, desinfección y monitoreo ambiental de las áreas limpias con el objetivo fundamental de garantizar que las producciones se realicen en ambientes adecuados y que las áreas controladas permanezcan dentro de los parámetros establecidos, para ello se establecen un conjunto de límites de alertas y de acción, de forma tal que se pueda evaluar el desempeño del área y tomar acciones correctivas cuando se requiera según los principios de Buenas Prácticas de Producción Farmacéutica.

  16. FERTILIZANTES DE SOLUBILIDAD CONTROLADA EN EL CULTIVO DE TRIGO EN EL BAJÍO: BALANCE DE N

    OpenAIRE

    José Antonio Vera-Núñez; Oscar Arath Grageda-Cabrera; Martín Eduardo Ávila-Miranda; Javier Zaragoza Castellanos-Ramos; José Iván Escalante-García; Alexander Gorokovsky; Juan José Peña-Cabriales

    2012-01-01

    Los fertilizantes de alta eficiencia y solubilidad controlada representan una alternativa para incrementar la absorción de nutrimentos en cultivos agrícolas. Los objetivos del presente trabajo fueron cuantificar la absorción y la residualidad del N proveniente de fertilizantes compuestos de solubilidad controlada (FCSC: AUK1 y AGUMFA4) en el sistema trigo-suelo, con diferentes manejos (labranza tradicional y labranza de conservación) en El Bajío, empleando la técnica isotópica de 15N. Asimism...

  17. Câmara frigorifica com atmosfera controlada para conservação de produtos frutícolas refrigerados

    OpenAIRE

    Almeida, Daniel Mendes de

    2015-01-01

    O trabalho de projeto final de Mestrado, corresponde à conceção de uma câmara frigorífica com atmosfera controlada para conservação de produtos frutícolas refrigerados, em que o fruto escolhido foi o kiwi. Foi feito uma caracterização do fruto e principais propriedades e enquadramento da sub-fileira do kiwi em Portugal. Foram abordados os fatores de conceção da câmara frigorífica com atmosfera controlada e apresentadas as diferenças relativamente ...

  18. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  19. Continuous subcutaneous pethidine for routine postoperative analgesia.

    OpenAIRE

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

    1985-01-01

    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.

  20. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    Institute of Scientific and Technical Information of China (English)

    Lorella; Fanti; Pier; Alberto; Testoni

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...

  1. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    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.

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

    Science.gov (United States)

    Morishima, Hisayo O

    2007-09-01

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    Directory of Open Access Journals (Sweden)

    Varaprasad

    2015-07-01

    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 .

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

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    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.

  6. RESPOSTA HEMATOLÓGICA DE CÃES APÓS UMA SANGRIA CONTROLADA

    OpenAIRE

    Irene Breitsameter; Luiz Carlos Ribeiro Fan; Cláudio Corrêa Natalini; Sonia Terezinha dos Anjos Lopes

    1992-01-01

    As alterações hemáticas de 10 cães (7 fêmeas e 3 machos) submetidos a uma sangria controlada, foram observadas durante 28 dias. A sangria correspondeu a remoção de 20ml de sangue por kg. A avaliação laboratorial foi realizada em tempos anteriores e subseqüentes à sangria. Os animais, após a sangria, apresentaram um decréscimo nos parâmetros eritrocitários sendo o ponto mínimo no tempo 5, (72 horas após à sangria) com valores abaixo do normal, o retorno aos valores iniciais ocorreu no tempo 7 ...

  7. Armazenamento de caqui (Diospyros kaki, L.) cv. Quioto, em atmosfera controlada

    OpenAIRE

    DONAZZOLO JOEL; BRACKMANN AURI

    2002-01-01

    Objetivou-se avaliar, com o presente trabalho, o efeito da temperatura e do CO2 no armazenamento em atmosfera controlada sobre a conservação de caqui cv. Quioto. Foram avaliadas as temperaturas -1,0 e -0,5ºC, e pressões parciais de CO2 de 0; 5 e 10kPa, com os tratamentos arranjados em um esquema bifatorial. Os frutos foram avaliados após 3 meses de armazenamento mais 3 dias de exposição à temperatura ambiente (18-20ºC). Conforme os resultados, não foi constatada interação entre os fatores, ha...

  8. Neonatal respiratory depression associated with epidural analgesia

    Directory of Open Access Journals (Sweden)

    Alberto Gálvez Toro

    2013-06-01

    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

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

    Science.gov (United States)

    Mercadante, Sebastiano; Porzio, Giampiero; Gebbia, Vittorio

    2012-05-01

    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

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

    LENUS (Irish Health Repository)

    2012-02-29

    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.

  11. Bloqueio combinado raquiperidural versus bloqueio peridural contínuo para analgesia de parto em primigestas: resultados maternos e perinatais Combined spinal-epidural block versus continuous epidural block in labor analgesia for primiparous women: newborns and women outcomes

    Directory of Open Access Journals (Sweden)

    Márcio Antonio de Souza

    2009-10-01

    Full Text Available OBJETIVOS: comparar a evolução materna e perinatal após a utilização da analgesia peridural contínua versus analgesia combinada raqui-peridural em parturientes primigestas. MÉTODOS: foi realizado ensaio clínico aleatorizado com 128 gestantes primigestas em trabalho de parto, divididas em dois grupos: analgesia peridural (APC com 65 mulheres e grupo analgesia combinada raqui-peridural (ACRP com 63, admitidas no pré-parto de duas maternidades na cidade de Jundiaí - SP. Foram estudadas as variáveis: tempo de latência de instalação da analgesia, intensidade da dor e tempo total decorrido até a dilatação completa, índice de Apgar no primeiro e quinto minutos, tempo de resolução do parto, grau de bloqueio motor, efeitos adversos como náuseas, vômitos, prurido, hipotensão arterial, e grau de satisfação materna. Foram critérios de inclusão: primigestas, estado físico ASA 1 e 2, feto único, apresentação cefálica, de termo, dilatação cervical de 3 a 6 cm e solicitação de analgesia pelo obstetra. Foram excluídas mulheres com morbidades, ruptura de membranas, anormalidades fetais e uso de opioides até quatro horas antes. Para a análise estatística utilizou-se o teste de Mann-Whitney para as variáveis contínuas não paramétricas e os testes exato de Fisher e χ2 de Pearson, para variáveis categóricas. RESULTADOS: não houve diferença entre os grupos para velocidade de dilatação cervical, tempo para resolução do parto, parâmetros hemodinâmicos maternos, vitalidade do recém-nascido, complementações analgésicas durante o trabalho de parto e modo de parto. Houve maior rapidez de instalação da analgesia no grupo da ACRP e menor bloqueio motor no grupo de APC. Não foram observadas diferenças em relação aos efeitos adversos como náuseas, vômitos, prurido e hipotensão, sendo hipotensão mais frequente no grupo APC (16,9 versus 6,3% e náusea no grupo ACRP (6,3 versus 3,1%. CONCLUSÕES: as duas t

  12. Developments in labour analgesia and their use in Australia.

    Science.gov (United States)

    Eley, V A; Callaway, L; van Zundert, A A

    2015-07-01

    Since the introduction of chloroform for labour analgesia in 1847, different methods and medications have been used to relieve the pain of labour. The use of heavy sedative medication in the early 1900s was encouraged by enthusiastic doctors and by women empowered by the women's suffrage movement in America. Nitrous oxide by inhalation has been used in Australia since the 1950s and improved methods of administration have made this method of analgesia safe and practical. Caudal epidural analgesia and lumbar epidural analgesia were first made popular in America and by the 1970s these techniques were more widely available in Australia. In 1847, physicians and the public were unsure whether relieving labour pains was the 'right' thing to do. However, many medical and social changes have occurred thanks to the clinical connection between Australia and the United Kingdom and those first settlers to land on Australian shores. Thanks to this historical connection, in today's Australia there is no question that women should use analgesia as a pain relief if they wish. Currently, the majority of women worldwide use some form of analgesia during labour and different methods are widely available. This paper discusses the four milestones of the development of obstetric analgesia and how they were introduced into patient care in Australia. PMID:26126071

  13. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  14. Analgesia pós-operatória em cesarianas com a associação de morfina por via subaracnóidea e antiinflamatório não esteróide: diclofenaco versus cetoprofeno

    Directory of Open Access Journals (Sweden)

    Hirahara Jacqueline Toshiko

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação de baixas doses de morfina subaracnóidea e diclofenaco por via muscular tem se mostrado eficaz para o controle da dor pós-operatória em pacientes submetidas à cesariana sob raquianestesia. O cetoprofeno pode ser vantajoso em relação ao diclofenaco, já que sua administração pode ser realizada por via venosa. O objetivo do estudo foi comparar a eficácia analgésica do diclofenaco e do cetoprofeno, quando administrados em associação com baixas doses de morfina subaracnóidea no pós-operatório imediato de pacientes submetidas à cesariana sob raquianestesia. MÉTODO: Foram estudadas prospectivamente 44 pacientes estado físico ASA I ou II submetidas à cesariana sob raquianestesia com 15 mg de bupivacaína hiperbárica e 28 µg de morfina. Após 90 minutos do início da anestesia, as pacientes foram divididas aleatoriamente em dois grupos que receberam: Grupo D (n = 22: 75 mg de diclofenaco por via muscular e Grupo C (n = 22: 100 mg de cetoprofeno em 100 ml de solução glicosada a 5% por via venosa, em 20 minutos. A dor foi avaliada com a escala analógica visual de dor (EAV - 0 cm indicando ausência de dor e 10 cm indicando dor insuportável, imediatamente antes e a cada hora após a administração do antiinflamatório (AINE, por um período de 6 horas. A analgesia complementar foi realizada utilizando-se a bomba de analgesia controlada pelo paciente (ACP por via venosa, com bolus de 1 mg de morfina, intervalo de bloqueio de 7 minutos, sem infusão basal e dose máxima de morfina de 20 mg em 4 horas. Avaliou-se a dor, a necessidade de utilização de medicação analgésica de resgate, o consumo cumulativo de morfina nas seis primeiras horas após a administração do AINE, e a ocorrência de prurido, náusea, vômito e depressão respiratória. RESULTADOS: Os grupos D e C foram semelhantes em relação às médias de dor e doses cumulativas de morfina na ACP nas seis primeiras horas ap

  15. RESPOSTA HEMATOLÓGICA DE CÃES APÓS UMA SANGRIA CONTROLADA

    Directory of Open Access Journals (Sweden)

    Irene Breitsameter

    1992-04-01

    Full Text Available As alterações hemáticas de 10 cães (7 fêmeas e 3 machos submetidos a uma sangria controlada, foram observadas durante 28 dias. A sangria correspondeu a remoção de 20ml de sangue por kg. A avaliação laboratorial foi realizada em tempos anteriores e subseqüentes à sangria. Os animais, após a sangria, apresentaram um decréscimo nos parâmetros eritrocitários sendo o ponto mínimo no tempo 5, (72 horas após à sangria com valores abaixo do normal, o retorno aos valores iniciais ocorreu no tempo 7 (14 dias após a sangria. A porcentagem de reticulócitos refletiu uma estimulação leve da medula óssea que também foi observada pela diminuição da relação M/E que teve o ponto mínimo no tempo 6 (7 dias após a sangria.

  16. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pelo acesso perivascular inguinal, chamado de bloqueio 3 em 1, tem sido utilizado para analgesia pós-operatória. O objetivo deste estudo foi comparar a analgesia pós-operatória do bloqueio 3 em 1 a da morfina subaracnóidea em pacientes submetidos a cirurgias ortopédicas em membro inferior (MI. MÉTODO: Foram estudados 40 pacientes escalados para cirurgia ortopédica de MI, de ambos os sexos, estado físico ASA I e II, com idades entre 15 e 75 anos, distribuídos em 2 grupos (M e BPL. Foi realizada anestesia subaracnóidea em todos os pacientes, em L3-L4 ou L4-L5, com 20 mg de bupivacaína isobárica a 0,5%. No grupo M (n = 20 foi associado 50 µg de morfina ao anestésico local. No grupo BPL (n = 20 foi realizado o bloqueio 3 em 1 ao término da cirurgia, utilizando 200 mg de ropivacaína a 0,5%. Avaliou-se a analgesia e a intensidade da dor às 4, 8, 12, 14, 16, 20 e 24 horas após o término da cirurgia, o nível do bloqueio subaracnóideo, o tempo cirúrgico e as complicações. RESULTADOS: A duração da analgesia no grupo BPL foi de 13,1 ± 2,47, enquanto no grupo M todos os pacientes referiam dor e ausência de bloqueio motor no primeiro instante avaliado (4 horas. Houve falha do bloqueio de um dos 3 nervos em 3 pacientes. A incidência de náusea e prurido foi significativamente maior no grupo M. Quanto à retenção urinária, não houve diferença significante entre os grupos. Não houve depressão respiratória, hipotensão arterial ou bradicardia. A analgesia pós-operatória foi mais efetiva no grupo BPL, comparada ao grupo M às 4, 8, 12,14 e 16 horas. Às 20 e 24 horas não houve diferença significante entre os grupos. CONCLUSÕES: A analgesia pós-operatória proporcionada pelo bloqueio 3 em 1 apresentou efeitos colaterais inferiores à morfina subaracnóidea com tempo de analgesia semelhante.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del plexo lumbar por el acceso

  17. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    ;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly...... better analgesic effects, and also fewer unwanted side effects. Although opioids have played a prominent role in postoperative analgesia for centuries and are still often administered as a matter of routine, their frequent minor side effects and the increasing availability of suitable alternatives may...... relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing...

  18. Meningitis tras anestesia y analgesia espinal

    OpenAIRE

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

    2013-01-01

    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...

  19. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Harsimran Singh

    2013-01-01

    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.

  20. Fetal circulation during epidural analgesia for caesarean section.

    OpenAIRE

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

    1984-01-01

    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.

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

    Science.gov (United States)

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

    2016-08-01

    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

  2. Hipotensão controlada induzida por halotano em coelhos Halothane induced controlled hypotension in rabbits

    Directory of Open Access Journals (Sweden)

    Nubia Verçosa Figueiredo

    2003-10-01

    Full Text Available OBJETIVO: Descrever e analisar um estudo experimental com o objetivo de pesquisar o uso do halotano em diferentes concentrações, visando à obtenção de hipotensão induzida ou controlada e à análise das repercussões hemodinâmicas decorrentes do método. MÉTODO: Foram utilizados vinte e nove coelhos (Oryctolagus cuniculus, do tipo Nova Zelândia subdivididos em quatro grupos, dentre os quais havia um controle composto por cinco animais, e outros três contendo oito coelhos cada um. Os grupos I,II e III (n=8 cada foram submetidos a um período de hipotensão induzida, utilizando-se o halotano em concentrações de 1,0%, 1,5% e 2,0%, respectivamente. Foram avaliadas as freqüências cardíaca (FC e respiratória (FR, a pressão arterial média (PAM e a temperatura corporal. No sangue arterial analisaram-se os valores do potencial hidrogeniônico (pH, da pressão parcial do oxigênio (PaO2, da pressão parcial do gás carbônico (PaCO2, do bicarbonato (-HCO3, do excesso de bases (BE, da saturação do oxigênio da hemoglobina (Sat.O2. Estes parâmetros foram obtidos em três momentos: antes (MAnH, durante (MDuH e após (MApH a hipotensão induzida. Acompanhou-se, periodicamente, os reflexos corneano e pupilar e, de forma contínua, o eletrocardiograma. RESULTADOS: A análise estatística dos resultados evidenciou hipotensão e redução de frequência cardíaca com o uso do halotano. O pH dos coelhos é mais alcalino que o do homem. Não obstante haver uma tendência à acidose metabólica, esta decorreu de uma condição transitória, sem comprometer a homeostase. CONCLUSÃO: O halotano é um anestésico seguro e eficaz para promover a hipotensão induzida ou controlada, em coelhos.BACKGROUND: The authors describe haemodynamic changes secondary to controlled and induced hypotension during anesthesia with different halothane concentrations. METHODS: Twenty-nine New Zealand white rabbits (Oryctolagus cuniculus were divided into four groups

  3. Armazenamento de caqui (Diospyros kaki, L. cv. Quioto, em atmosfera controlada

    Directory of Open Access Journals (Sweden)

    DONAZZOLO JOEL

    2002-01-01

    Full Text Available Objetivou-se avaliar, com o presente trabalho, o efeito da temperatura e do CO2 no armazenamento em atmosfera controlada sobre a conservação de caqui cv. Quioto. Foram avaliadas as temperaturas -1,0 e -0,5ºC, e pressões parciais de CO2 de 0; 5 e 10kPa, com os tratamentos arranjados em um esquema bifatorial. Os frutos foram avaliados após 3 meses de armazenamento mais 3 dias de exposição à temperatura ambiente (18-20ºC. Conforme os resultados, não foi constatada interação entre os fatores, havendo efeito significativo para temperatura somente na firmeza de polpa, em que -1,0ºC apresentou frutos mais firmes. As diferentes pressões parciais de CO2 não influenciaram a perda de peso e a firmeza de polpa. As podridões apresentaram uma resposta linear negativa em relação ao CO2, porém, mantendo elevada ocorrência. Valores de CO2 entre 5 e 10kPa proporcionaram frutos com menor índice de escurecimento de epiderme e com coloração mais amarela e vermelha. O CO2 entre 5 e 10kPa apresentou os melhores resultados, que somados à temperatura de -1,0ºC, foi a melhor condição de armazenamento, que, no entanto, teve o período de conservação inferior a três meses nesta condição, devido às altas perdas por podridões.

  4. Armazenamento de grãos residuais de urucum sob atmosfera controlada

    Directory of Open Access Journals (Sweden)

    Juliana G. de Brito

    2015-12-01

    Full Text Available RESUMO Neste trabalho avaliou-se a estabilidade de grãos residuais de urucum acondicionados em embalagens flexíveis laminadas durante 90 dias de armazenamento em condições controladas de temperatura (25 e 40 °C e umidades relativas (55 e 83%. As amostras foram analisadas a cada 15 dias, por meio da análise do teor de água, atividade de água, pH, acidez titulável, cor (luminosidade, intensidade de vermelho e intensidade de amarelo proteína bruta, amido e bixina. Observou-se, no decorrer dos tempos de armazenamento, que as embalagens não evitaram a absorção de água acarretando em aumentos do teor de água (42,62; 43,06; 41,78 e 42,90%, atividade de água (6,39; 6,94; 5,97 e 6,94%, acidez titulável (12,28; 13,79; 9,09 e 13,79% e luminosidade (4,48; 12,18; 4,73; 4,91% e ocorreram reduções na intensidade de vermelho (8,19; 7,77; 4,66 e 7,93%, pH (9,21; 8,56; 12,44 e 18,12 e bixina (51,72;56,32; 57,47 e 55,17% respectivamente, para as seguintes combinações de umidades relativas e temperaturas (55% e 25 ou 40 °C; 85% e 25 ou 40 °C.

  5. Manejo do etileno em ameixas 'Laetitia' armazenadas sob atmosferas controlada e modificada ativa

    Directory of Open Access Journals (Sweden)

    Thais Roseli Corrêa

    2011-09-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito de condições de atmosfera controlada (AC e atmosfera modificada (AM ativa (filme PEBD de 40 µm, com duas perfurações de 1,0 mm de diâmetro, associadas ao manejo do etileno, sobre a manutenção da qualidade em ameixas 'Laetitia'. Os tratamentos avaliados consistiram no armazenamento refrigerado (60 dias a 0,5±0,1ºC em: atmosfera refrigerada (AR; 21,0 kPa O2 + <0,03 kPa CO2; AM; AM + baixo etileno (BE; AC; e AC + 1-MCP (1,0 µL L-1. As pressões parciais de O2 + CO2 (kPa foram de 1,0 + 1,0 e 2,5 + <0,1, em AC e AM, respectivamente. Os frutos armazenados em AC, independentemente do tratamento com 1-MCP, apresentaram retardo no amadurecimento, quando comparados aos frutos em AR. Contudo, os melhores resultados para a manutenção da textura da polpa e da acidez titulável foram obtidos em AC + 1-MCP. Os tratamentos não interferiram para a incidência de podridões, rachaduras e degenerescência da fruta. Frutos dos tratamentos AM + BE e AC + 1-MCP apresentaram menor escurecimento da polpa e maior aceitabilidade quanto à cor e ao sabor na análise sensorial em relação àqueles armazenados em AR.

  6. Resposta da maçã cv. Fuji ao etileno no armazenamento em atmosfera controlada Response of Fuji apples to ethylene in controlled atmosphere storage

    Directory of Open Access Journals (Sweden)

    Auri Brackmann

    2001-12-01

    Full Text Available Conduziu-se um experimento com o objetivo de avaliar o efeito das concentrações de etileno sobre a manutenção da qualidade e ocorrência de distúrbios fisiológicos na maçã cv. Fuji armazenada em atmosfera controlada (AC com 1kPa de O2 e 0,2kPa de CO2 na temperatura de 0,5ºC. O delineamento experimental foi o inteiramente casualizado com três repetições. Os tratamentos avaliados foram: 0,25; 20; e, 800m.L-1 de etileno. As avaliações foram realizadas após nove meses de armazenamento, no momento da abertura das câmaras e após sete dias de exposição a 25ºC. Somente os frutos mantidos em 800m.L-1 de etileno durante o período de conservação em AC foram influenciados pelo etileno, apresentando maior respiração e síntese de etileno, menor firmeza de polpa e cor de fundo da epiderme mais amarela do que aqueles armazenados com 0,25 ou 20m.L-1 de etileno na atmosfera da câmara. A maçã 'Fuji' apresentou baixa sensibilidade a altas concentrações de etileno durante o armazenamento em AC, não se justificando a sua absorção em câmaras comerciais.The experiment was carried out aiming to evaluate the effect of ethylene concentrations on the quality and occurrence of physiological disorders on Fuji apples stored in controlled atmosphere (CA with 1kPa O2 / 0,2kPa CO2 at 0.5ºC. The treatments applied were: 0.25; 20; and 800m.L-1 ethylene. The evaluations were accomplished after nine months of storage, at the opening of the chambers and after seven days in shelf life (25ºC. Only the fruits kept at 800m.L-1 ethylene during storage period were influenced by the ethylene, showing higher respiration and ethylene biosynthesis, lower firmness and more yellow background color of the peel than those stored with 0.25 or 20m.L-1. Fuji apples presented low sensibility to high ethylene concentrations during storage in AC, therefore absorption is not recomended in commercial storage rooms.

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

    OpenAIRE

    Fábio Ely Martins Benseñor; Domingos Dias Cicarelli

    2003-01-01

    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...

  8. Meningitis tras anestesia y analgesia espinal

    Directory of Open Access Journals (Sweden)

    M. Robles Romero

    2013-08-01

    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

  9. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

    Directory of Open Access Journals (Sweden)

    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  10. Hidrogeles basados en poloxámeros con estructura de estrella para liberación controlada de sustancias activas

    OpenAIRE

    Parra Ruiz, Jesús; San Román, Julio; Rodríguez Alonso, Lucena; Herrero Vanrell, María del Rocio; Vázquez Lasa, Blanca

    2009-01-01

    Hidrogeles basados en poloxámeros con estructura de estrella para liberación controlada de sustancias activas. La presente invención describe un compuesto basado en poloxámeros y un hidrogel que comprende estos compuestos, así como el uso de estos hidrogeles como vehículos para la administración de sustancias activas o como adyuvantes en composiciones farmacéuticas, especialmente en las que se administran por vía tópica ocular

  11. Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia.

    Science.gov (United States)

    Honigman, Liat; Yarnitsky, David; Sprecher, Elliot; Weissman-Fogel, Irit

    2013-08-01

    The endogenous analgesia (EA) system is psychophysically evaluated using various paradigms, including conditioned pain modulation (CPM) and offset analgesia (OA) testing, respectively, the spatial and temporal filtering processes of noxious information. Though both paradigms assess the function of the EA system, it is still unknown whether they reflect the same aspects of EA and consequently whether they provide additive or equivalent data. Twenty-nine healthy volunteers (15 males) underwent 5 trials of different stimulation conditions in random order including: (1) the classic OA three-temperature stimulus train ('OA'); (2) a three-temperature stimulus train as control for the OA ('OAcon'); (3) a constant temperature stimulus ('constant'); (4) the classic parallel CPM ('CPM'); and (5) a combination of OA and CPM ('OA + CPM'). We found that in males, the pain reduction during the OA + CPM condition was greater than during the OA (P = 0.003) and CPM (P = 0.07) conditions. Furthermore, a correlation was found between OA and CPM (r = 0.62, P = 0.01) at the time of maximum OA effect. The additive effect found suggests that the two paradigms represent at least partially different aspects of EA. The moderate association between the CPM and OA magnitudes indicates, on the other hand, some commonality of their underlying mechanisms.

  12. Condições de atmosfera controlada para o armazenamento de maçãs 'Royal Gala' de diferentes tamanhos

    OpenAIRE

    Brackmann Auri; Giehl Ricardo Fabiano Hettwer; Antes Rose Beatriz; Neuwald Daniel Alexandre; Sestari Ivan; Pinto Josuel Alfredo Vilela

    2005-01-01

    O objetivo deste trabalho foi avaliar o efeito de condições de atmosfera controlada sobre a conservação da qualidade de maçãs 'Royal Gala' de tamanho pequeno (5-6cm de diâmetro) e grande (8-9cm de diâmetro). Os frutos foram armazenados durante oito meses em atmosfera controlada, seguido de sete dias a 20degreesC. De acordo com os resultados obtidos, verificou-se que a condição de atmosfera controlada com 1,5kPa de O2 + 3,0kPa de CO2 permitiu melhor conservação dos frutos pequenos, por permiti...

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

    DEFF Research Database (Denmark)

    Andersen, Karen V; Bak, Marie; Christensen, Birgitte V;

    2010-01-01

    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...

  14. The efficacy of structured assessment and analgesia provision in the paediatric emergency department

    OpenAIRE

    Boyd, R.; Stuart, P

    2005-01-01

    Objectives: To ascertain if the use of a structured pain assessment tool and nurse initiated oral analgesia protocols improve uptake and time to analgesia for children presenting to the emergency department with minor or moderate musculoskeletal injuries.

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

    Science.gov (United States)

    Reuben, S S; Steinberg, R B

    2000-09-01

    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

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

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    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.

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

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    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.

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

    OpenAIRE

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

    2011-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Fábio Ely Martins Benseñor

    2003-09-01

    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

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

    DEFF Research Database (Denmark)

    Kehlet, H; Werner, M; Perkins, F

    1999-01-01

    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 ...

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

    Science.gov (United States)

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

    1985-03-01

    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

  2. Classical conditioning and pain: conditioned analgesia and hyperalgesia.

    Science.gov (United States)

    Miguez, Gonzalo; Laborda, Mario A; Miller, Ralph R

    2014-01-01

    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

  3. The neuroanatomy of sexual dimorphism in opioid analgesia.

    Science.gov (United States)

    Loyd, Dayna R; Murphy, Anne Z

    2014-09-01

    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

  4. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

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

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    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.

  6. Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

    Science.gov (United States)

    Won, Young Ju; Lim, Byung Gun; Lee, So Hyun; Park, Sangwoo; Kim, Heezoo; Lee, Il Ok; Kong, Myoung Hoon

    2016-01-01

    Abstract Background: The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy. Methods: Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores. Results: Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit. Conclusions: SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy. PMID:27583920

  7. Evaluación de un inhibidor utilizado en soluciones acidas bajo condiciones hidrodinámicas controladas

    Directory of Open Access Journals (Sweden)

    Salinas-Bravo, V. M.

    1997-06-01

    Full Text Available The cylindrical rotating electrode and electrochemical techniques were used to investigate the protection against corrosion of a commercial inhibitor used in hydrochloric acid solutions with and without additions of thiourea and ammonium bifluoride. The corrosion phenomenon was investigated under controlled hydrodynamic conditions. These were chosen to simulate those found in a pipe at different flow velocities. It was found that corrosion of mild steel in hydrochloric acid solutions with inhibitor is mainly controlled by activation, whereas in acid solutions with inhibitor added with thiourea and ammonium bifluoride it is mainly controlled by mass transfer. On the other hand, flow velocity of the acidic solutions affects negatively the efficiency of the inhibitor in the concentration range of 0.2 to 1.0 %.

    Utilizando el electrodo cilíndrico rotatorio y técnicas electroquímicas, se estudió la eficiencia de la protección contra la corrosión de un inhibidor comercial utilizado en soluciones de ácido clorhídrico con y sin adiciones de tiourea y bifluoruro de amonio. El fenómeno de la corrosión se investigó en condiciones hidrodinámicas controladas, seleccionadas para simular las que se establecen en una tubería a distintas velocidades de flujo. Se encontró que la corrosión del acero al carbono en soluciones de ácido clorhídrico con inhibidor de corrosión está controlada principalmente por activación, mientras que en soluciones acidas con inhibidor y adiciones de tiourea y bifluoruro de amonio está controlada principalmente por transferencia de masa. Por otra parte, la velocidad del flujo de las soluciones acidas afecta de -manera negativa a la eficiencia de protección del inhibidor estudiado en el intervalo de concentración de 0,2 a 1,0 %.

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

    Science.gov (United States)

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

    2010-11-01

    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

  9. Liposomal extended-release bupivacaine for postsurgical analgesia

    Directory of Open Access Journals (Sweden)

    Lambrechts M

    2013-09-01

    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

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

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    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...... should aim at including physical rehabilitation programs in the pain treatment regimen....

  11. Multimodal analgesia for perioperative pain in three cats.

    Science.gov (United States)

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

    2013-08-01

    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

  12. Inhaled analgesia for pain management in labour (Review)

    NARCIS (Netherlands)

    Klomp, T.; Poppel, M. van; Jones, L.; Lazet, J.; Nisio, M. Di; Lagro-Janssen, A.L.M.

    2012-01-01

    BACKGROUND: Many women would like to have a choice in pain relief during labour and also would like to avoid invasive methods of pain management in labour. Inhaled analgesia during labour involves the self-administered inhalation of sub-anaesthetic concentrations of agents while the mother remains a

  13. Efeitos adversos do sufentanil associado ao anestésico local pelas vias subaracnóidea e peridural em pacientes submetidas à analgesia de parto Efectos adversos del sufentanil asociado al anestésico local por las vías subaracnoidea y peridural en pacientes sometidas a la analgesia de parto Side effects of subarachnoid and epidural sufentanil associated with a local anesthetic in patients undergoing labor analgesia

    Directory of Open Access Journals (Sweden)

    Isabel C.F. Salem

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação do opióide ao anestésico local melhora a qualidade da analgesia de parto e reduz o risco de toxicidade sistêmica pelo anestésico local. Os opióides, entretanto, podem determinar efeitos colaterais. O objetivo desta pesquisa foi comparar os efeitos adversos determinados pelo sufentanil, administrado por via subaracnóidea, associado à bupivacaína, com aquele determinado pelo sufentanil por via peridural, associado à ropivacaína, nas doses utilizadas no Serviço de Anestesia, em gestantes submetidas à analgesia de parto. MÉTODO: Participaram do estudo 60 pacientes, estado físico ASA I e II, com idade entre 15 e 42 anos, com gestação a termo e fetos saudáveis, submetidas à analgesia de parto. Foram distribuídas de forma aleatória em dois grupos: G1 - Duplo bloqueio - bupivacaína a 0,5% (2,5 mg e sufentanil (5 µg pela via subaracnóidea, G2 - Peridural - ropivacaína a 0,2% (20 mg e sufentanil (10 µg pela via peridural. Para doses complementares foi administrada ropivacaína a 0,2% (12 mg e para resolução do parto, ropivacaína a 1% (50 mg. As pacientes foram avaliadas após analgesia (M1 com relação a hipotensão arterial, bradicardia materna, prurido, náusea, vômito, depressão respiratória e sedação. No pós-operatório (M2, quanto à presença de náusea, vômito, prurido, sedação, retenção urinária e dor. Os recém-nascidos foram avaliados pelo índice de Apgar. Para análise estatística, foram utilizados teste t de Student, Mann-Whitney e Qui-quadrado. RESULTADOS: Os grupos foram similares com relação à idade, ao peso, à altura, à duração do período de trabalho de parto após analgesia, ao Apgar dos recém-nascidos, à ocorrência de hipotensão arterial, bradicardia, náusea, vômito, prurido e retenção urinária. A sedação foi mais freqüente nas pacientes de G2, em M1 (50% com diferença estatística significativa. CONCLUSÕES: O sufentanil nas doses

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

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    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.

  15. Síntesis de nuevos materiales para el desarrollo de sistemas de liberación controlada

    Directory of Open Access Journals (Sweden)

    Liván Alba-Gutierrez

    2011-01-01

    Full Text Available El estudio abarcó la síntesis y caracterización de materiales con potencialidades para su empleo en sistemas de liberación controlada (SLC para el sector agrícola, incorporando derivados de la agroindustria azucarera cubana como celulosa microcristalina, acetato de celulosa y dextrana. Se utilizó una técnica de síntesis no convencional por medio de la irradiación ultrasónica que permitió la obtención de poliuretanos poco solubles en agua y en disolventes orgánicos como: dimetilsulfóxido, dimetilformamida, etanol y acetato de etilo. Estas características, favorecen su utilización como SLC en medio acuoso alcanzándose capacidad de liberación de urea durante un periodo de 724 horas.

  16. Testes de envelhecimento acelerado e deterioração controlada na avaliação do vigor de aquênios de girassol Accelerated aging and controlled deterioration seeds vigour tests for sunflower

    Directory of Open Access Journals (Sweden)

    Madelon Rodrigues Sá Braz

    2008-10-01

    Full Text Available Os testes de vigor têm sido desenvolvidos para diferenciar os lotes de sementes devido às limitações impostas pelo teste de germinação. O objetivo do trabalho foi analisar a eficiência dos testes de envelhecimento acelerado e deterioração controlada na avaliação do vigor de lotes de aquênios de girassol. Para tanto, cinco lotes de aquênios (sementes com o pericarpo de girassol da cultivar "Catissol 01" foram submetidos à determinação do grau de umidade e à avaliação da qualidade fisiológica, empregando os testes de germinação e vigor (primeira contagem, teste de frio, condutividade elétrica, emergência de plântulas, índice de velocidade de emergência, envelhecimento acelerado pelos sistemas tradicional e com solução saturada de NaCl a 42°C por 48, 72, 96 horas e deterioração controlada com teor inicial de água de 15, 20, 25% por 48, 72, 96 horas a 42°C. Os resultados permitiram concluir que o teste de envelhecimento acelerado com solução saturada de NaCl por 96 horas foi eficiente para classificar os lotes de aquênios de girassol. As combinações de 20% de água nos aquênios por 72 horas de exposição e de 25% de água nos aquênios por 48 e 72 horas de exposição permitem classificar os lotes de aquênios de girassol.The vigour tests were developed to detect differences of seeds lots owing to limitations the germination test. This study was conducted to compare different procedures of the accelerated aging and controlled deterioration tests to evaluate sunflowers seed vigour. Five lots of sunflower achenes (seeds with pericarp cv. Catissol 01 were submitted to the water content test and to the evaluation of physiological quality using by germination and vigour test (first count, cold test, electrical conductivity, seedling emergence and speed of emergence index, accelerated aging with tradicional system and satured solution of NaCl, at 42°C for 48, 72, 96 hours and controlled deterioration with 15, 20

  17. Recubrimientos de pisos en áreas controladas de la producción de biológicos

    Directory of Open Access Journals (Sweden)

    Pedro A. Rodríguez

    2007-12-01

    Full Text Available El recubrimiento de los pisos, utilizando las resinas sintéticas autonivelantes en la construcción de las áreas controladas, empleadas en las instalaciones de producción de biológicos, en las dedicadas a los procesos de manipulación de microorganismos (contención, así como en las instalaciones para los animales de laboratorio y procesos asépticos de formulación farmacéutica, contribuyen a la seguridad biológica y farmacéutica, según sea el caso, por su continuidad integral y garantía de la calidad microbiológica del aire, así como al ahorro energético, pues disminuyen la ganancia de calor latente atribuido a la humedad incorporada al aire por otros recubrimientos permeables. Las condiciones climáticas de Cuba y la dureza del agua empleada en las mezclas cementosas son un alto potencial para la formación de "burbujas", tema abordado en este trabajo. El conocimiento de los aspectos que provocan la formación de estas ampollas y las vías para evitarlo, son útiles y de un valor apreciable. En este artículo se presentan las experiencias obtenidas con la aplicación de los recubrimientos epoxídicos en las áreas controladas del Instituto Finlay, instalaciones que no han presentado deformaciones apreciables después de 15 años de explotación.

  18. 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

    Directory of Open Access Journals (Sweden)

    Augustin Malzac

    2009-06-01

    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

  19. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

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

    Science.gov (United States)

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

    1987-01-01

    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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation of the evide......BACKGROUND: Thoracotomy induces severe postoperative pain and impairment of pulmonary function, and therefore regional analgesia has been intensively studied in this procedure. Thoracic epidural analgesia is commonly considered the "gold standard" in this setting; however, evaluation...... of the 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...

  2. The impact of patients controlled analgesia undergoing orthopedic surgery

    OpenAIRE

    Aluane Silva Dias; Tathyana Rinaldi; Luciana Gardin Barbosa

    2016-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Concetta Polizzi

    2013-06-01

    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.

  4. [Systemic analgesia for postoperative pain management in the adult].

    Science.gov (United States)

    Binhas, M; Marty, J

    2009-02-01

    Severe postsurgical pain contributes to prolonged hospital stay and is also believed to be a risk factor for the development of chronic pain. Locoregional anesthesia, which results in faster patient recovery with fewer side effects, is favored wherever feasible, but is not applicable to every patient. Systemic analgesics are the most widely used method for providing pain relief in the postoperative period. Improvements in postoperative systemic analgesia for pain management should be applied and predictive factors for severe postoperative pain should be anticipated in order to control pain while minimizing opioid side effects. Predictive factors for severe postoperative pain include severity of preoperative pain, prior use of opiates, female gender, non-laparoscopic surgery, and surgeries involving the knee and shoulder. Pre- and intraoperative use of small doses of ketamine has a preventive effect on postoperative pain. Multimodal or balanced analgesia (the combined use of various analgesic agents) such as NSAID/morphine, NSAID/nefopam, morphine/ketamine improves analgesia with morphine-sparing effects. Nausea and vomiting, the principle side effects of morphine, can be predicted using Apfel's simplified score; patients with a high Apfel score risk should receive preemptive antiemetic agents aimed at different receptor sites, such as preoperative dexamethasone and intraoperative droperidol. Droperidol can be combined with morphine for postoperative patient-controlled anesthesia (PCA). When PCA is used, dosage parameters should be adjusted every day based on pain evaluation. Patients with presurgical opioid requirements will require preoperative administration of their daily opioid maintenance dose before induction of anesthesia: PCA offers useful options for effective postsurgical analgesia using a basal rate equivalent to the patient's hourly oral usage plus bolus doses as required.

  5. ANALGESIA PREEMPTIVA EM ODONTOLOGIA – REVISÃO DE LITERATURA

    OpenAIRE

    Roberto Pena C. BAPTISTA; Márcio Gilberto ZANGERÔNIMO; SOUSA, Raimundo Vicente DE; Leandro Silva MARQUES; Pereira, Luciano José

    2011-01-01

    Preemptive analgesia is a type of antinoceptive therapy which aims preventing both centraland peripheral sensitizations, decreasing (or preferentially preventing) post-operative amplification of pain.This study had as main objective to carry out a literature review associated with the theme, seeking to identify the effectiveness of the technique and additionally to propose a pharmacological protocol with rational use of medicinal products available on the Brazilian market. The review of liter...

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

    OpenAIRE

    English, R E; Chen, J. H.

    2010-01-01

    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 ...

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

    OpenAIRE

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

    2013-01-01

    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-...

  8. [Preemptive analgesia for postoperative pain after frontotemporal craniotomy].

    Science.gov (United States)

    Honnma, Toshimi; Imaizumi, Toshio; Chiba, Masahiko; Niwa, Jun

    2002-02-01

    Two thirds of patients suffer from moderate to severe pain after frontotemporal craniotomy. We think neurosurgeons must try to reduce the postoperative pain, which may induce postoperative hypertension, restlessness, and pathological pains. To investigate how preemptive analgesia effects postoperative pain, we assessed the pain in 20 consecutive patients who underwent neck clipping for non-ruptured cerebral aneurysms of anterior circulation systems by frontotemporal craniotomies. Ten patients underwent preemptive analgesia with four procedures (preemptive group) as follows, 1) oral administration of long-acting non-steroid anti inflammatory drug (NSAID, ampiroxicam) two hours before the surgical operation, 2) nerve blockades of the supra-orbital nerve and the infra-orbital nerve by bupivacaine, 3) local anesthesia of the scalp along the marker of a skin incision by xylocaine, 4) local anesthesia by bupivacaine along a skin incision after the skin closure. Ten patients of the control group underwent only procedure No. 3. Visual analog pain score (VAS) for postoperative pain 6, 12, and 24 hours, and 3, 5, 7, and 14 days after operation and NSAID administration for the pain were evaluated. Patients of the preemptive group had significantly less postoperative pain during the whole post-surgery period and required less administration of NSAID than the control group. Preemptive analgesia procedures No. 1, 2 and 4 reduced the postoperative pain and the total administration of NSAID. Postoperative pain may be reduced after other types of brain surgery, with proper nerve blocks like procedure No. 2, procedures No. 1, 3 and 4. PMID:11857941

  9. Tratamento da leishmaniose tegumentar americana pelo niridazol

    Directory of Open Access Journals (Sweden)

    Miroslau Constante Baranski

    1970-08-01

    Full Text Available Foi empregue o niridazol um derivado do nitrotiazol, em doze pacientes com leishmaniose tegumentar americana. Em todos êles, o diagnóstico clínico da doença foi confirmado pela biópsia das lesões e em oito dêles também pela positividade da intradetermorreação de Montenegro. Oito pacientes tinham lesões mucosas metastáticas em atividade e lesões cutâneas iniciais cicatrizadas há tempo mais ou menos longo. Dois apresentavam concomitância de lesões cutâneas e mucosas em atividade, e dois tinham lesões cutâneas exclusivas. A duração da doença variou de 2 meses a 32 anos. A posologia diária do niridazol foi uniformememente de 25 mg/kg de pêso corpóreo. O medicamento foi administrado por via oral, em duas tomadas diárias, sempre com o doente internado em hospital. Quando a tolerância o permitia, o paciente recebia cinco séries de tratamento de 10 dias de duração cada, intercaladas por períodos áe suspensão da droga de 10 dias entre uma série e outra. Isso foi possível em 10 dos 12 pacientes. O tratamento foi bem tolerado em 5 doentes e de tolerância regular em 4. Mal tolerado em um paciente pela ocorrência de alucinações e excitação mental e interrompido pela péssima tolerância em dois doentes devido ao aparecimento de convulsões generalizadas com perda da consciência. O tratamento acompanhou-se de grande incidência, de efeitos colaterais. A ocorrência de para-efeitos mais intensos não foi devida às más condições hepáticas. Provas de função hepática. hemogramas, estudos bioquímicos do sangue e exames de urina, realizados antes, durante e após o tratamento, não revelaram alterações significativas. Biópsias hepáticas por punção com agulha em dez doentes, prévias e posteriores ao tratamento, não detectaram lesões hepáticas que pudessem ser atribuídas à medicação. O seguimento dos doentes prolongou-se pelo prazo de dois a 36 meses apos o tratamento. Alterações eletrocardiogr

  10. Toracotomia em eqüinos sob anestesia com ventilação mecânica controlada Equine thoracotomy under anesthesia with controlled mechanical ventilation (CMV)

    OpenAIRE

    Raquel Yvonne Arantes Baccarin; José de Alvarenga; Denise Tabachi Fantoni; Luís Cláudio Lopes Correia da Silva

    1998-01-01

    Diversos procedimentos cirúrgicos e diagnósticos podem ser realizados através da cirurgia torácica em eqüinos. Para tanto faz-se necessária a utilização da ventilação controlada mecânica (VCM) e a compreensão dos efeitos respiratórios deste tipo de ventilação durante a toracotomia. Foram utilizados seis eqüinos hígidos, sob anestesia com ventilação controlada, para a realização de acesso cirúrgico ao hemitórax direito com o objetivo de se avaliar, através da mensuração dos parâmetros fisiológ...

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

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2009-01-01

    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 ìg.ml-1 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 ml.hr-1 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

  12. Patient controlled intravenous analgesia with tramadol for labor pain relief

    Institute of Scientific and Technical Information of China (English)

    龙健晶; 岳云

    2003-01-01

    Objective To evaluate the safety and analgesic efficacy of patient controlled intravenous analgesia (PCIA) with tramadol, and to compare its benefits and risks with combined spinal-epidural analgesia (CSEA)+ patient controlled epidural analgesia (PCEA). Methods Eighty American Society of Anesthesiologist (ASA) Ⅰ-Ⅱ at term parturients in active labor were randomly divided into 3 groups: the control group (n=30) received no analgesia; group A (n=30) received spinal administration with ropivacaine 2.5 mg and fentanyl 5 μg, then with PCEA; group B (n=20) received 1 mg/kg tramadol loading dose I.v.. PCIA with 0.75% tramadol and it included: PCA dose 2 ml, lockout time 10 minutes, background infusion 2 ml/h, total dose no more than 400 mg. The intensity of pain was evaluated using Visual Analogue Scale (VAS). Results Both group A and B showed good pain relief. VAS pain scores were significantly decreased in group A and B compared with those in the control group (P<0.01). In comparison with group B, the VAS pain scores decreased in group A (P<0.05). The onset times of analgesia in group A were shorter than those in group B (P<0.05). Apgar scores in group B were lower than those in group A (P<0.05). The periods of second stage of labor in group A were longer than those in the control group and group B (P<0.05). The cesarean delivery rate was significantly higher in the control group (16.7%) than in group A (3.3%) and group B (5.0%), but it did not differ between group A and B. There were no significant differences in vital signs, fetal heart rate, degree of motor block, and uterine contractions among the 3 groups. Conclusions PCIA with tramadol is now a useful alternative when patients are not candidates for CSEA for labor, or do not want to have a neuraxial block anesthesia. However, sometimes it may not provide satisfactory analgesic effect.

  13. Sistema reproducible de presión negativa controlada de bajo costo, para curación de heridas problema

    Directory of Open Access Journals (Sweden)

    A.J. Serrano González-Rubio

    2013-06-01

    Full Text Available Como cirujanos plásticos nos enfrentamos con el manejo de heridas problema. Está descrito como opción de tratamiento la terapia con presión negativa. Como instrumento técnico se reconoce en la literatura al sistema Vacuum Assisted Closure-KCI® (San Antonio, Texas, EE.UU. como sistema comercialmente disponible. Su costo hace que no sea accesible para los pacientes de nuestra institución. Por esta razón diseñamos un sistema de presión negativa controlada para tratar estas lesiones. El sistema consiste en un manómetro de presión negativa instalado a una válvula bidireccional conectada en un extremo al sistema de presión negativa de pared del hospital y en el otro extremo a un tubo estéril de 1/4 de pulgada, conectado a su vez a un drenaje que se coloca sobre compresas estériles ubicadas sobre el área de la herida a tratar, que se sella con un adhesivo estéril. Tratamos con este sistema 14 pacientes con diversos tipos de heridas problemáticas logrando mejoría clínica de las mismas. Se utilizó también para mejorar la integración de los injertos de piel colocados sobre heridas problema.

  14. Enfriamiento de café pergamino seco a granel utilizando aireación mecánica controlada

    Directory of Open Access Journals (Sweden)

    Julio E. Ospina M.

    2011-01-01

    Full Text Available Con el fin de garantizar que el café almacenado a granel conserve su calidad durante el tiempo necesario de almacenamiento, se estudió el enfriamiento del café pergamino seco en silos experimentales de dimensiones: 0.5m x 0.5m y 2.8 m de altura, utilizando aire enfriado mecánicamente. Los rangos estudiados fueron: temperatura de 10 a 220C humedad relativa de 66 a 98%y contenido de humedad del grano de 8 a 13.57% b.h. Durante la etapa de almacenamiento se evaluó la variación de la calidad del café según los criterios de coloración de la almendra, población de microorganismos y prueba de taza; paralelamente se dejaron muestras almacenadas en sacosa las condiciones de Chinchiná, como muestra testigo buscando determinar la bondad del almacenamiento a granel, también se dejó un silo sin aireación para determinar el efecto de la aireación controlada en la calidad del café.

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

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    Ana Maria Calil

    2005-10-01

    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

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

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Parisa Golfam

    2011-03-01

    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.

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

    DEFF Research Database (Denmark)

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

    1988-01-01

    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...

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

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    Patti Kastanias

    2010-01-01

    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.

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

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    Neena Gupta

    2014-08-01

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...

  2. The impact of patients controlled analgesia undergoing orthopedic surgery

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    Aluane Silva Dias

    2016-06-01

    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.

  3. Imaging-guided hyperstimulation analgesia in low back pain.

    Science.gov (United States)

    Gorenberg, Miguel; Schwartz, Kobi

    2013-01-01

    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.

  4. Morphine versus oxycodone analgesia after percutaneous kidney stone surgery

    DEFF Research Database (Denmark)

    Pedersen, Katja Venborg; Olesen, Anne Estrup; Drewes, Asbjørn Mohr;

    2013-01-01

    effects (nausea, dizziness, sedation, respiratory effects and itching) were registered. The postoperative opioid consumption varied considerably between the patients but the mean opioid consumption in the morphine and oxycodone group was comparable (18.93 mg versus 16.15 mg, P = 0.7). Nausea...... was significantly less frequent with morphine (P = 0.03). In this study morphine and oxycodone produced similar analgesia the first 4 h after surgery but the frequency of nausea was significantly less patient-reported with morphine. The hypothesis that oxycodone would be superior in the treatment of visceral pain...

  5. INTRAVENOUS DEXMEDETOMIDINE FOR LABOUR ANALGESIA IN WOMEN WITH PREECLAMPSIA

    Directory of Open Access Journals (Sweden)

    Nidhi

    2016-06-01

    Full Text Available BACKGROUND Parenteral opioids and sedatives are the most frequently prescribed agents for women in labour in many poor resource settings. These have shown poor pain relief and a lot of side effects in both the mother and the foetus. In patients with severe pre-eclampsia who are already haemodynamically compromised labour pains and delivery can result in haemodynamic instability, which can compromise both the mother and the neonate. Dexmedetomidine is a highly selective α-2 agonist, which when used in recommended dose in the form of an infusion has several desirable properties like sedation, anxiolysis, sympatholysis, analgesia, decreased anaesthetic requirements, maintains cardiovascular stability and provides a smooth recovery. AIM The aim of this study was to study the haemodynamic effects of intravenous dexmedetomidine when used in patients with severe pre-eclampsia for labour analgesia. MATERIALS AND METHODS The study was conducted in the Department of Obstetrics and Gynaecology of Bundelkhand Medical College, Sagar, between January 2015 and December 2016; 40 labouring patients with severe pre-eclampsia were included in the study; 20 each were allocated to the study and control group. The study group received intravenous Dexmedetomidine in the recommended doses (1 ug/kg loading dose over 10-15 minutes followed by an infusion at 0.2-0.7 ug/kg/hour when in active labour, while the control group received Intravenous Fentanyl. The two groups were compared regarding the duration of labour, the mode of delivery, the neonatal outcome, the onset and duration of analgesia and maternal haemodynamic parameters during labour and delivery. The data obtained in this study was tabulated and analysed using the Chi-square test and the Z test with p value of 0.05 taken as significant. RESULTS It was found out that the group of patients who received Dexmedetomidine were more haemodynamically stable during labour and delivery; there was significant pain relief

  6. Regional anaesthesia and analgesia on the front line.

    Science.gov (United States)

    Scott, D M

    2009-11-01

    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

  7. Intravenous regional analgesia in a patient with Glanzmann thrombastenia.

    Science.gov (United States)

    Goksu, Sitki; Gul, Rauf; Ozen, Onder; Yilmaz, Mehmet; Buyukbebeci, Orhan; Oner, Unsal

    2010-02-01

    Glanzmann thrombastenia (GT) is a rare condition of an inherited autosomal recessive gene characterized with bleeding tendency. The condition is rarely met in the OR. and therefore it is essential that anesthesiologist be cognizant of the risk involved and be prepared with all necessary precautionary measures. We present a GT case in a 27-year-old male with a mass in the anticubital region of right wrist that was successfully excised using the non-invasive intravenous regional analgesia (IVRA). The use of platelet transfusion and the recombinant factor VIIa, are stressed.

  8. [Assessment of pain relief in patients receiving different variants of multimodal analgesia after major gynecological surgery].

    Science.gov (United States)

    Timerbaev, V H; Smimova, O V; Genov, P G; Olejnikova, O N; Rebrova, O Yu

    2014-01-01

    The major gynecology surgery generally results in severe postoperative pain. Currently multimodal analgesia concept is widely used for the aim of postoperative pain relief optimization. According to this theory it is worth using the medication with different mechanism in order to increase analgesia qualify, decrease analgesic consumption and avoid adverse reaction. Unfortunately the surveys recently conducted have been pointed out the postoperative analgesia quality is still insufficient despite of using the concept mentioned above. One way to solve the problem is appearing in daily practice nefopam--centrally acting non-opioid analgesic that inhibits reuptake of serotonin, norepinephrine, and dopamine and also mitigates glutamatergic neurotransmission. In this trial we tried to assess the postoperative daily used analgesia quality and potency of preemptive multimodal analgesia model consisted of nefopam, ketoprofen, paracetamol and morphine.

  9. Fentanyl versus tramadol with levobupivacaine for combined spinal-epidural analgesia in labor

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    Veena Chatrath

    2015-01-01

    Full Text Available Background: Neuraxial labor analgesia using new local anesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Combined spinal-epidural analgesia (CSEA has become the preferred method for labor analgesia as it combines benefits of both spinal analgesia and flexibility of the epidural catheter. Adding opioids to local anesthetic drugs provide rapid onset and prolonged analgesia but may be associated with several maternal and fetal adverse effects. The purpose of this study is to compare fentanyl and tramadol used in CSEA in terms of duration of analgesia and frequency of the adverse fetomaternal outcome. Materials and Methods: A total of 60 primiparas with a singleton pregnancy in active labor were given CSEA after randomly allocating them in two groups of 30 each. Group I received intrathecal 2.5 mg levobupivacaine + 25 μg fentanyl followed by epidural top ups of 20 ml 0.125% solution of the same combination. Group II received 25 mg tramadol instead of fentanyl. Epidural top ups were given when parturient complained of two painful contractions (visual analogue scale ≥ 4. Data collected were demographic profile of the patients, analgesic qualities, side- effects and the fetomaternal outcome. Results: Patients in Group II had significantly prolonged analgesia (145 ± 9 minutes than in Group I (95 ± 7 minutes. Patients receiving fentanyl showed rapid onset of analgesia, but there were more incidence of side-effects like shivering, pruritus, transient fetal bradycardia, hypotension, nausea and vomiting. Only side-effect in the tramadol group was nausea and vomiting. During labor, maternal satisfaction was excellent. Conclusions: Adding tramadol to local anesthetic provides prolonged analgesia with minimal side effects. Fentanyl, when used as adjuvant to local anesthetic, has a rapid onset of analgesia but has certain fetomaternal side-effects.

  10. Estudio embriológico de Iguana iguana (Linnaeus, 1758 bajo condiciones de incubación controladas

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    Ossa Velásquez Jaime de la

    2000-12-01

    Full Text Available

    Se realiza un estudio de Iguana iguana para establecer los estadios embrionarios que caracterizan la especie, bajo condiciones de incubaci6n artificial controladas de 32.5°C y humedad relativa promedio de 90% ± 2, colectándose y fijándose 5 huevos diarios a partir de la postura y durante 67 días. El peso promedio de los huevos fue de 15.4001 g, largo 3.84 mm, ancho 2.7 mm, notándose que estos son independientes del tiempo transcurrido de incubación. El peso de los embriones no presenció diferencias significativas durante los primeros 6 estadios (periodo embrionario, a partir del estadio 7 (periódo fetal existen valores que van de 1.5834 g a 7.2323 g. 14 dimensiones fueron evaluadas en cada embrión, encontrándose que todas están directamente relacionadas con el tiempo de incubación. Se establecieron 12 estadios embrionarios para Iguana iguana teniendo en cuenta una tipificación rnorfométrica y morfológica, lepidosis, organización de órganos, proceso mandibular, grade de diferenciación de bulbos en extremidades y presencia de lengua, entre otros. Los embriones de Iguana iguana continúan su desarrollo postovipuestos con la presencia de esbozo cardíaco y hepático. Al final del estadio 8 la porción distal de la lengua se observa dividida en dos. Solo en el estadio 12 se evidencian los dientes y e! ovirruptor o diente embrionario. Los hemipenes en embriones machos, se mantienen externos durante todo el proceso embrionario.

  11. Tratamento da himenolepíase pelo Thelmesan

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    Adelina de S. Velho Soli

    1967-12-01

    Full Text Available Os autores descrevem, os resultados com o emprego de um nôvo medicamento, o THELMESAN, na himenolepíase. Entre 48 casos estudados, 82% tiveram erradicação do parasitismo; a tolerância foi boa, enquanto outras parasitoses associadas não foram influenciadas pelo produto.

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

    Science.gov (United States)

    Dadure, C; Capdevila, X

    2007-02-01

    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

  13. 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

    Directory of Open Access Journals (Sweden)

    R. Ortiz de la Tabla

    2008-10-01

    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

  14. Naltrexone-sensitive analgesia following exposure of mice to 2450-MHz radiofrequency radiation (RFR)

    Energy Technology Data Exchange (ETDEWEB)

    Maillefer, R.H.; Quock, R.M. (Univ. of Illinois, Rockford (United States))

    1991-03-11

    This study was conducted to determine whether exposure to RFR might induce sufficient thermal stress to activate endogenous opioid mechanisms and induce analgesia. Male Swiss Webster mice, 20-25 g, were exposed to 10, 15 or 20 mV/cm{sup 2} RFR in a 2,450-MHz waveguide system for 10 min, then tested in the abdominal constriction paradigm. Specific absorption rates (SAR) were 23.7 W/kg at 10 mW/cm{sup 2}, 34.6 W/kg at 15 mW/cm{sup 2} and 45.5 W/kg at 20 mW/cm{sup 2}. Confinement in the exposure chamber alone did not appreciably alter body temperature but did appear to induce a stress-associated analgesia that was insensitive to the opioid receptor blocker naltrexone. Exposure of confined mice to RFR elevated body temperature and further increased analgesia in SAR-dependent manner. The high-SAR RFR-induced analgesia, but not the hyperthermia, was reduced by naltrexone. These findings suggest that (1) RFR produces SAR-dependent hyperthermia and analgesia and (2) RFR-induced analgesia is mediated by opioid mechanisms while confinement-induced analgesia involves non-opioid mechanisms.

  15. Preparación y evaluación en suelo de fertilizantes de liberación controlada cubiertos con polímeros biodegradables

    OpenAIRE

    Aguilar Ráquira, Íngrid Yadira

    2014-01-01

    En este trabajo se describe la preparación de fertilizantes de liberación controlada incorporados en matrices poliméricas basadas en almidón, xantano, alginato y quitosan. Las formulaciones fueron preparadas mediante la mezcla y posterior tableteado de los fertilizantes sólidos (NH4)2HPO4 y KCl junto con la matriz polimérica. Se realizaron ensayos de liberación en agua y CaCl2 0.01 N para comparar el perfil de liberación de las diferentes formulaciones, en las cuales se contrastó el perfil de...

  16. Influencia de la respiración controlada en las cifras de presión arterial de pacientes con hipertensión arterial

    OpenAIRE

    Merino Serna, Maitane

    2013-01-01

    La hipertensión arterial es un problema de salud pública de gran dimensión, constituyendo el factor de riesgo cardiovascular más frecuente en nuestro país. Su alta prevalencia y la posibilidad de ejercer un buen control tanto de la patología en sí misma, como de sus consecuencias derivadas, la convierten en un problema de gran interés sociosanitario. Por todo ello, el propósito de este proyecto de investigación es investigar la eficacia de la respiración controlada y de las técnicas de relaja...

  17. Calidad óptica objetiva y subjetiva de una lente RPG con refracción periférica controlada para control de miopía

    OpenAIRE

    Mayordomo Jodar, Ana Isabel

    2011-01-01

    Estudiar la calidad óptica objetiva y subjetiva de la lente experimental (refracción periférica controlada), en comparación con una lente RPG esférica convencional y con gafa u ojo desnudo. 1. Evaluar las aberraciones ópticas inducidas por la lente experimental, en comparación a la corrección convencional de lente RPG esférica y ojo desnudo. 2. Analizar la posible influencia de la modificación de la refracción periférica en la sensibilidad al contraste central en comparación con RPG exp...

  18. Maçã 'Gala' armazenada em atmosfera controlada e tratada com aminoetoxivinilglicina e ethephon 'Gala' apple stored in controlled atmosphere and treated with aminoethoxyvinylglycine and ethephon

    OpenAIRE

    Cristiano André Steffens; Ricardo Fabiano Hettwer Giehl; Auri Brackmann

    2005-01-01

    O objetivo deste trabalho foi avaliar o efeito da aplicação pré-colheita de aminoetoxivinilglicina (AVG) e ethephon sobre a qualidade da maçã 'Gala', armazenada em atmosfera controlada. Os tratamentos avaliados foram: controle; ethephon (140 g ha-1); AVG (125 g ha-1); AVG (125 g ha-1) + ethephon (140 g ha-1); AVG (95 g ha-1); e AVG (95 g ha-1) + ethephon (140 g ha-1). Os tratamentos foram associados a três épocas de colheita: 131, 138 e 145 dias após pleno florescimento. O AVG e o ethephon fo...

  19. Conservação pós-colheita do milho verde minimamente processado sob atmosfera controlada e refrigeração

    OpenAIRE

    Alexandra Mara Goulart Nunes Mamede; Marcos José de Oliveira Fonseca; Antonio Gomes Soares; Israel Alexandre Pereira Filho; Ronoel Luiz de Oliveira Godoy

    2015-01-01

    O consumo de espigas de milho verde com endosperma normal é tradicional, no Brasil, e a sua comercialização in natura é cada vez maior no mercado de produtos minimamente processados, mostrando a necessidade de mais estudos a respeito de sua vida útil. O objetivo deste trabalho foi avaliar a influência de duas atmosferas controladas (2% O2 + 8% CO2, 4% O2 + 8% CO2) e atmosfera ambiente, na qualidade de milho verde, do tipo normal Embrapa HT1, minimamente processado, durante 12 dias de armazena...

  20. Aspectos experimentales de la determinacion de curvas esfuerzodeformacion a alta temperatura y en atmosfera controlada:Refractarios Al2O3-MgO-C

    OpenAIRE

    Muñoz, V.; Rohr, G. A.; Tomba, Q. G.

    2011-01-01

    Se presenta una metodología diseñada e implementada en el Laboratorio de Materiales Estructurales de la División Cerámicos del INTEMA para la evaluación del comportamiento mecánico de materiales refractarios a altas temperaturas y en atmósfera controlada. La metodología comprende la determinación de la deformación por extensometría de contacto en ensayos en compresión con el fin de obtener curvas esfuerzo-deformación y el uso de un sistema de control de atmósfera por desplazamient...

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

    Directory of Open Access Journals (Sweden)

    Torvaldsen Siranda

    2010-04-01

    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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    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....

  3. Controversy of the use of epidural analgesia in labour

    Directory of Open Access Journals (Sweden)

    Enrique Ramón Arbués

    2008-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Sherrie Lessans

    2013-01-01

    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.

  5. Imaging-guided hyperstimulation analgesia in low back pain

    Directory of Open Access Journals (Sweden)

    Gorenberg M

    2013-06-01

    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

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

    Science.gov (United States)

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

    2005-12-01

    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

  7. Prolonged gabapentin analgesia in an experimental mouse model of fibromyalgia

    Directory of Open Access Journals (Sweden)

    Ueda Hiroshi

    2008-11-01

    Full Text Available Abstract In a new mouse model for generalized pain syndrome, including fibromyalgia, which used intermittent cold stress (ICS, bilateral allodynia in the hindpaw was observed that lasted more than 12 days; thermal hyperalgesia lasted 15 days. During constant cold stress (CCS, mice showed only a transient allodynia. A female prevalence in ICS-induced allodynia was observed in gonadectomized but not in gonad intact mice. Systemic gabapentin showed complete anti-allodynic effects in the ICS model at the one-tenth dose for injury-induced neuropathic pain model, and central gabapentin showed long-lasting analgesia for 4 days in ICS, but not the injury model. These results suggest that the ICS model is useful for the study of generalized pain syndrome.

  8. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Daniel Espada Lahoz

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional para cirurgias oftalmológicas oferece vantagens, como: mínimas alterações fisiológicas, anestesia completa, bloqueio dos reflexos oculares, pequena incidência de náuseas e vômitos, menor tempo de recuperação e analgesia pós-operatória. A preocupação constante com a qualidade do bloqueio, assim como da abordagem da analgesia pós-operatória deve ficar sob a responsabilidade do anestesiologista. O objetivo deste estudo foi avaliar se o fentanil contribui na qualidade do bloqueio extraconal e na analgesia pós-operatória de facectomias com implante de lente intra-ocular. MÉTODO: Estudou-se a associação do fentanil e bupivacaína a 0,75% na qualidade do bloqueio ocular e na analgesia pós-operatória em 164 pacientes submetidos a facectomia com implante de lente intra-ocular (técnica extracapsular, de ambos os sexos com homogeneidade de parâmetros antropométricos, olho operado, classificação do estado físico (ASA e índice de risco cardíaco de Goldman. Os pacientes foram distribuídos em dois grupos (82 pacientes em cada grupo por sorteio de forma aleatória, com e sem fentanil. Avaliou-se a qualidade do bloqueio por: aparecimento da dor no per-operatório, manutenção de movimentação das pálpebras ou do globo ocular, persistência do reflexo de Bell, número de bloqueios realizados para a obtenção de condições cirúrgicas e avaliação do bloqueio pelo cirurgião. A analgesia pós-operatória foi avaliada pela necessidade de complementação analgésica pelo paciente. RESULTADOS: Fentanil associado à solução anestésica no bloqueio extraconal aumentou significativamente o bloqueio do músculo reto medial (com fentanil - 17,1%, sem fentanil - 32,9% e diminuiu o consumo de analgésicos no período pós-operatório (uso de analgésicos com fentanil - 20,7%, não uso de analgésicos com fentanil - 41,5%. CONCLUSÕES: Nas condições deste estudo o fentanil

  9. Blockade of tolerance to morphine analgesia by cocaine.

    Science.gov (United States)

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

    1989-07-01

    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

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

    Directory of Open Access Journals (Sweden)

    Gabriela R Lauretti

    2013-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Adeniji AO

    2013-05-01

    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. Crescimento in vitro de fungos (Colletotrichum gloeosporioides e Cladosporium cladosporioides) isolados de frutos do mamoeiro, sob atmosfera controlada e refrigeração In vitro growth of Colletotrichum gloeosporioides and Cladosporium cladospodioides under controlled atmosphere and refrigeration

    OpenAIRE

    Daniela Gouveia Vieira; Roberta Manhães da Silva; Otniel Freitas Silva; Marcos José de Oliveira Fonseca; Antônio Gomes Soares; Roberto Alexandre Costa

    2006-01-01

    O uso combinado das tecnologias de atmosfera controlada e de refrigeração, em frutas tropicais, não apresenta ainda resultados satisfatórios, talvez pela suscetibilidade à injúria por frio, agravada nas condições de controle atmosférico. Como há indícios de que a atmosfera controlada tem efeito fungistático, este trabalho foi elaborado para se verificar, in vitro, sua influência sobre dois fungos fitopatogênicos do mamão: Colletotrichum gloeosporioides e Cladosporium cladosporioides, sob refr...

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

    DEFF Research Database (Denmark)

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

    2005-01-01

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......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......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  14. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first weekand at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence on...

  15. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

  16. Analgesia in hip fractures. Do fascia-iliac blocks make any difference?

    OpenAIRE

    Callear, Jacqueline; Shah, Ku

    2016-01-01

    Despite recent national advances in the care for the hip fracture patient, significant morbidity and mortality persists. Some of this morbidity is attributable to the analgesia provided in the hospital setting. The National Institute of Health and Care Excellence and the Association of Anaesthetists of Great Britain and Ireland recommend the use of simple oral analgesia including opioids, with fascia-iliac blocks (FIB) used as an adjunct. Literature review reveals a paucity of evidence on thi...

  17. [Labor epidural analgesia for a woman with a pityriasis versicolor in the lumbar region].

    Science.gov (United States)

    Dubar, G; Omarjee, M; Viguié, C; Barbarot, S; Mignon, A

    2011-01-01

    Epidural analgesia is usually contraindicated in case of infection at the site of needle insertion. Tinea versicolor is a benign superficial cutaneous fungal infection caused by the proliferation of a skin commensal yeast of low pathogenicity. We report the case of a pregnant woman with a tinea versicolor in the lumbar region, who benefited from a labor epidural analgesia, realised with reinforced antiseptic measures. No neurological or infectious complication occurred.

  18. Intraarticular vs. extraarticular ropivacaine infusion following high-dose local infiltration analgesia after total knee arthroplasty

    OpenAIRE

    Dobrydnjov, Igor; Anderberg, Christian; Olsson, Christer; Shapurova, Olga; Angel, Krister; Bergman, Stefan

    2011-01-01

    Background and purpose Ropivacaine infusion following high-volume local infiltration analgesia has been shown to be effective after total knee arthroplasty, but the optimum site of administration of ropivacaine has not been evaluated. We compared the effects of intraarticular and extraarticular adminstration of the local anesthetic for postoperative supplementation of high-volume local infiltration analgesia. Patients and methods In this double-blind study, 36 rheumatic patients aged 51–78 ye...

  19. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

    OpenAIRE

    Akanksha Lamba; Priya Sardana; Ramanjeet Kaur

    2016-01-01

    Background: The pain of childbirth is one of the most severe types of pain that a woman experiences in her lifetime. Adequate analgesia during labour has a positive influence on the course of labour. For labor analgesia several non-pharmacologic and pharmacologic methods are adopted. The objective of the study is to compare parenteral tramadol and epidural ropivacaine with regard to maternal and labour outcome. Methods: This prospective, comparative, interventional clinical study was condu...

  20. A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia

    OpenAIRE

    Heo, Bong Ha; Park, Ji Hun; Choi, Jung Il; Kim, Woong Mo; Lee, Hyoung gon; Cho, Soo Young; Yoon, Myoung Ha

    2015-01-01

    Background Ketorolac has been used as a postoperative analgesia in combination with opioids. However, the use of ketorolac may produce serious side effects in vulnerable patients. Propacetamol is known to induce fewer side effects than ketorolac because it mainly affects the central nervous system. We compared the analgesic effects and patient satisfaction levels of each drug when combined with fentanyl patient-controlled analgesia (PCA). Methods The patients were divided into two groups, eac...

  1. Comparison of parenteral tramadol and epidural ropivacaine for labour analgesia: a prospective clinical study

    Directory of Open Access Journals (Sweden)

    Akanksha Lamba

    2016-06-01

    Conclusions: Maternal outcome in labour analgesia is similar with 100 mg I/M tramadol and epidural ropivacaine. There is no significant difference between duration of labour, rate of LSCS, incidence of instrumental delivery and neonatal outcome in the two modes of analgesia. Analgesic efficacy with epidural ropivacaine seems to be better compared to intramuscular tramadol. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1722-1727

  2. Mediation of buprenorphine analgesia by a combination of traditional and truncated mu opioid receptor splice variants.

    Science.gov (United States)

    Grinnell, Steven G; Ansonoff, Michael; Marrone, Gina F; Lu, Zhigang; Narayan, Ankita; Xu, Jin; Rossi, Grace; Majumdar, Susruta; Pan, Ying-Xian; Bassoni, Daniel L; Pintar, John; Pasternak, Gavril W

    2016-10-01

    Buprenorphine has long been classified as a mu analgesic, although its high affinity for other opioid receptor classes and the orphanin FQ/nociceptin ORL1 receptor may contribute to its other actions. The current studies confirmed a mu mechanism for buprenorphine analgesia, implicating several subsets of mu receptor splice variants. Buprenorphine analgesia depended on the expression of both exon 1-associated traditional full length 7 transmembrane (7TM) and exon 11-associated truncated 6 transmembrane (6TM) MOR-1 variants. In genetic models, disruption of delta, kappa1 or ORL1 receptors had no impact on buprenorphine analgesia, while loss of the traditional 7TM MOR-1 variants in an exon 1 knockout (KO) mouse markedly lowered buprenorphine analgesia. Loss of the truncated 6TM variants in an exon 11 KO mouse totally eliminated buprenorphine analgesia. In distinction to analgesia, the inhibition of gastrointestinal transit and stimulation of locomotor activity were independent of truncated 6TM variants. Restoring expression of a 6TM variant with a lentivirus rescued buprenorphine analgesia in an exon 11 KO mouse that still expressed the 7TM variants. Despite a potent and robust stimulation of (35) S-GTPγS binding in MOR-1 expressing CHO cells, buprenorphine failed to recruit β-arrestin-2 binding at doses as high as 10 µM. Buprenorphine was an antagonist in DOR-1 expressing cells and an inverse agonist in KOR-1 cells. Buprenorphine analgesia is complex and requires multiple mu receptor splice variant classes but other actions may involve alternative receptors. PMID:27223691

  3. Permanent lesion in rostral ventromedial medulla potentiates swim stress-induced analgesia in formalin test

    OpenAIRE

    Ali Shamsizadeh; Neda Soliemani; Mohammad Mohammad-Zadeh; Hassan Azhdari-

    2014-01-01

    Objective(s): There are many reports about the role of rostral ventromedial medulla (RVM) in modulating stress-induced analgesia (SIA). In the previous study we demonstrated that temporal inactivation of RVM by lidocaine potentiated stress-induced analgesia. In this study, we investigated the effect of permanent lesion of the RVM on SIA by using formalin test as a model of acute inflammatory pain. Materials and Methods: Three sets of experiments were conducted: (1) Application of stress proto...

  4. TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain.

    Science.gov (United States)

    Liu, Boyi; Fan, Lu; Balakrishna, Shrilatha; Sui, Aiwei; Morris, John B; Jordt, Sven-Eric

    2013-10-01

    Menthol, the cooling natural product of peppermint, is widely used in medicinal preparations for the relief of acute and inflammatory pain in sports injuries, arthritis, and other painful conditions. Menthol induces the sensation of cooling by activating TRPM8, an ion channel in cold-sensitive peripheral sensory neurons. Recent studies identified additional targets of menthol, including the irritant receptor, TRPA1, voltage-gated ion channels and neurotransmitter receptors. It remains unclear which of these targets contribute to menthol-induced analgesia, or to the irritating side effects associated with menthol therapy. Here, we use genetic and pharmacological approaches in mice to probe the role of TRPM8 in analgesia induced by L-menthol, the predominant analgesic menthol isomer in medicinal preparations. L-menthol effectively diminished pain behavior elicited by chemical stimuli (capsaicin, acrolein, acetic acid), noxious heat, and inflammation (complete Freund's adjuvant). Genetic deletion of TRPM8 completely abolished analgesia by L-menthol in all these models, although other analgesics (acetaminophen) remained effective. Loss of L-menthol-induced analgesia was recapitulated in mice treated with a selective TRPM8 inhibitor, AMG2850. Selective activation of TRPM8 with WS-12, a menthol derivative that we characterized as a specific TRPM8 agonist in cultured sensory neurons and in vivo, also induced TRPM8-dependent analgesia of acute and inflammatory pain. L-menthol- and WS-12-induced analgesia was blocked by naloxone, suggesting activation of endogenous opioid-dependent analgesic pathways. Our data show that TRPM8 is the principal mediator of menthol-induced analgesia of acute and inflammatory pain. In contrast to menthol, selective TRPM8 agonists may produce analgesia more effectively, with diminished side effects. PMID:23820004

  5. Understanding Central Mechanisms of Acupuncture Analgesia Using Dynamic Quantitative Sensory Testing: A Review

    OpenAIRE

    Jiang-Ti Kong; Schnyer, Rosa N; Johnson, Kevin A.; Sean Mackey

    2013-01-01

    We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS) and conditioned pain modulation (CPM) are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the a...

  6. Distúrbios causados pelo frio e pelo calor durante corridas de longa distância

    Directory of Open Access Journals (Sweden)

    1999-06-01

    Full Text Available Muitos corredores amadores e de elite participam todos os anos de corridas de longa distância. Quando estes eventos ocorrem em temperaturas altas ou baixas, aumenta o risco de distúrbios térmicos. Contudo, a hipertermia induzida pelo exercício, a hipotermia, a desidratação e outros problemas relacionados podem ser minimizados através de esclarecimentos e um preparo antes do evento. Este documento fornece recomendações para o diretor médico e outras autoridades da organização das corridas nas seguintes áreas: planejamento, profissionais envolvidos na organização, instalações, suprimentos, equipamento e comunicação; fornecimento de esclarecimentos aos participantes; avaliação do estresse térmico; fornecimento de líquidos; e prevenção de questões legais em potencial. Este posicionamento oficial também descreve as condições predisponentes, as formas de diagnóstico e o tratamento dos quatro distúrbios ambientais mais comuns: exaustão pelo calor, colapso pelo calor, hipotermia e congelamento de extremidades. Os objetivos deste documento são: 1 Educar os organizadores e os participantes de corridas de longa distância a respeito das formas mais comuns de distúrbios térmicos incluindo as condições predisponentes, sinais de alerta, suscetibilidade e a redução de sua incidência; 2 Alertar os organizadores sobre as suas responsabilidades civis em potencial no que concerne à segurança do evento e à prevenção de lesões; 3 Recomendar que os organizadores consultem arquivos locais de meteorologia e planejem eventos em horas que provavelmente causem menos estresse térmico de modo a minimizar os efeitos deletérios sobre os participantes; 4 Estimular os organizadores a alertar os participantes sobre o estresse térmico no dia da corrida e as suas implicações no que tange aos distúrbios causados pelo frio e pelo calor; 5 Informar os organizadores sobre as ações preventivas que podem reduzir a incidência dos

  7. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589

  8. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    Science.gov (United States)

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

  9. Analgesia en el paciente con abdomen agudo: ¿persiste el peligro? Analgesia in patients with acute abdomen: does danger persist?

    OpenAIRE

    Juan Camilo Correa Gallego; Edward Alexander Blandón Castaño

    2006-01-01

    INTRODUCCIÓN: el dolor abdominal es un motivo de consulta frecuente. Dado que se presenta como el síntoma principal en diversas enfermedades y que existe la posibilidad de que se generen complicaciones si el diagnóstico no se establece oportunamente, ha habido renuencia a brindar analgesia en forma temprana en estos casos. Los cambios en el ejercicio médico actual permiten preguntarse si está aún justificada la conducta de mantener a estos pacientes sin analgesia. MATERIALES Y MÉTODOS: se rea...

  10. ALIMENTOS CONSUMIDOS PELOS ALUNOS DE ESCOLAS DE TEMPO INTEGRAL

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    Marina VIEIRA DA SILVA

    2009-07-01

    Full Text Available

    Descreve-se o consumo alimentar de amostra (n = 224 de alunos matriculados em escolas de tempo integral do município de Americana, Estado de São Paulo. Utilizou-se o registro de alimentos ingeridos pelos escolares, durante 3 dias não consecutivos da semana. Para a definição das recomendações de energia e nutrientes, adotou-se padrão proposto por Martins & Hidalgo para a população brasileira. Com o objetivo de conhecer a qualidade nutricional, utilizou-se o índice proposto por Sorenson & Hansen. Entre os princípais resultados destacam-se: o consumo de lácteos que ocorre de forma praticamente exclusiva no desjejum (efetuado nas escolas e o elevado número de citações de consumo de pão, embutidos e refrigerantes em domicílio. Esse resultado sugere que os escolares estão substituindo, sobretudo, o jantar tradicional por lanches, considerados, pelos jovens, de maior praticidade. Quanto à qualidade nutricional da dieta, ressaltam-se os elevados valores do índice de Qualidade Nutricional (IQN, verificados para o ácido ascórbico, e números superiores a 1,0, observados para o IQN do ferro das refeições da maioria dos escolares analisados, com exceção somente para as refeições consumidas pelos alunos de maior idade (13 anos ou mais. Recomenda- se a correção de falhas no conteúdo nutricional das refeições distribuidas nas escolas, pois elas constituem parte fundamental do consumo alimentar dos alunos das escolas de tempo integral.

  11. Efeitos do óxido nitroso em hipotensão controlada durante anestesia com baixo fluxo

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    Semiha Barçın

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1 foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6 mg.kg-1 e brometo de vecurônio (0,08 0,12 mg.kg-1 foram administrados na indução de ambos os grupos. Isoflurano (2% foi administrado para manutenção da anestesia. O Grupo N recebeu uma mistura de 50% de O2-N2O e o Grupo A recebeu uma mistura de 50% de O2-ar como gás de transporte. Anestesia com baixo fluxo (1 L.min-1 foi iniciada após um período de 10 minutos de alto fluxo inicial (4,4 L.min-1. Os valores de pressão arterial, frequência cardíaca, saturação periférica de O2, isoflurano inspiratório e expiratório, O2 inspiratório e expiratório, N2O inspiratório e expiratório, CO2 inspiratório, concentração de CO2 após expiração e concentração alveolar mínima foram registrados. Além disso, as taxas de consumo total de fentanil, dexmedetomidina e isoflurano, bem como de hemorragia, foram determinadas. RESULTADOS: A frequência cardíaca diminuiu em ambos os grupos após a carga de dexmedetomidina. Após a intubação, os valores do Grupo A foram maiores nos minutos um, três, cinco, 10 e 15. Após a intubação, os valores de hipotensão desejados foram alcançados em 5 minutos no Grupo N e em 20 minutos no grupo A. Os valores da CAM foram mais altos no Grupo N nos minutos um, três, cinco, 10 e 15 (p < 0,05. Os valores da FiO2 foram mais altos entre 5 e 60 minutos no Grupo A, enquanto foram mais altos no Grupo N aos 90 minutos (p < 0,05. Os valores de Fi Iso (isoflurano inspiratório foram menores no Grupo N nos minutos

  12. Sedação e analgesia em neonatologia Sedación y analgesia en neonatología Sedation and analgesia in neonatology

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    Yerkes Pereira e Silva

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais. A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.JUSTIFICATIVA Y OBJETIVOS: La importancia del estudio del dolor en neonatología se debe al hecho de que la sensación de dolor y de estrés significa sufrimiento e incomodidad para los recién nacidos y, a pesar de ese conocimiento poco se ha hecho para reducirlo. Dentro de esa revisión se discutieron: la prevención del dolor, las medidas no farmacológicas ye farmacológicas para su tratamiento y la sedación en recién nacidos. CONTENIDO: Varias son las medidas no-farmacológicas que pueden ser tomadas con el objetivo de prevenir el

  13. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  14. A Study of Fetomaternal Outcome of Epidural Analgesia During Labour

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    Shital H Halvadia

    2013-04-01

    Full Text Available Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%, forceps delivery in 4 patients (5%, ventouse in 14 patients (17.5% and caesarean section in 16 patients (20%. At one minute majority of the babies (n 63, 78.75% had Apgar score of more than 7, only 5 babies (6.25% had Apgar score less than 4, and 12 babies (15% had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5% had Apgar score of more than 7, only one baby (1.25% had Apgar score less than 4, and 5 babies (6.25% had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient. [Natl J Med Res 2013; 3(2.000: 184-186

  15. Occult Spinal Dysraphism in Obstetrics: A Case Report of Caesarean Section with Subarachnoid Anaesthesia after Remifentanil Intravenous Analgesia for Labour

    Directory of Open Access Journals (Sweden)

    A. Valente

    2012-01-01

    Full Text Available Neuraxial techniques of anaesthesia and analgesia are the current choice in obstetrics for efficacy and general low risk of major complications. Concern exists about neuraxial anaesthesia in patients with occult neural tube defects, regarding both labour analgesia and anaesthesia for Caesarean section. Recently, remifentanil infusion has been proposed as an analgesic technique alternative to lumbar epidural, especially when epidural analgesia appears to be contraindicated. Here, we discuss the case of a pregnant woman attending at our institution with occult, symptomatic spinal dysraphism who requested labour analgesia. She was selected for remifentanil intravenous infusion for labour pain and then underwent urgent operative delivery with spinal anaesthesia with no complications.

  16. Eletroacupuntura na analgesia trans e pós-operatória de cadelas submetidas à ovariosalpingohisterectomia

    Directory of Open Access Journals (Sweden)

    L.C.C. Santos

    2015-12-01

    Full Text Available Objetivou-se com este estudo avaliar o efeito analgésico trans e pós-operatório da eletroacupuntura em onda denso-dispersa e frequências 3 e 200Hz, nos pontos E44, R3 e BP4, compará-lo com a analgesia promovida pelos pontos BP6, E36 e VB 34, e pela morfina, em cadelas submetidas à ovariosalpingohisterectomia (OSH. Teve-se como hipótese que a eletroacupuntura nos pontos E44, R3 e BP4 resultaria em controle da dor trans e pós-operatória melhor ou igual àquele promovido pela eletroacupuntura nos pontos BP6, E36 e VB34 e pela morfina. Trinta e seis cadelas submetidas à cirurgia eletiva de OSH foram distribuídas em blocos ao acaso em três grupos com 12 animais. Em dois grupos foi realizada eletroacupuntura denso-dispersa, com frequência de 3 e 200Hz, sendo que, no primeiro grupo (GEA, foram estimulados os pontos BP4, E44, R3 e, no segundo grupo (GEB, os pontos BP6, E36, VB34. Nesses dois grupos, foram administrados 1,5mL de solução fisiológica por via IM. No terceiro grupo (GF, foi realizada acupuntura em três pontos falsos e o aparelho de eletroacupuntura foi acoplado, mas não foi ligado, e administrou-se morfina na dose de 0,5mg/kg, diluída em solução fisiológica de modo que o volume total foi de 1,5mL por via IM. Foram avaliados os parâmetros cardiovasculares e respiratórios durante o período pré e transoperatório. A avaliação de dor pós-operatória foi realizada durante 12 horas, e a analgesia suplementar com morfina foi realizada quando o escore de dor alcançou valores iguais ou superiores a nove pontos (total de 27 de acordo com a "Escala de dor da Universidade de Melbourne" (EDUM. O grupo GEB apresentou pressão arterial estável, menor variação da Etiso e menor requerimento analgésico no pós-operatório. Nos grupos GEA e GF houve aumento da Etiso e da pressão arterial nos momentos de maior manipulação cirúrgica. Os maiores escores de dor foram obtidos em MP0 (momento da extubação no GEA (8 e em MP1(1h

  17. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

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    Summayah Fallatah

    2016-01-01

    Full Text Available Background: Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB, which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection. Materials and Methods: Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients or postoperative intravenous PCA with morphine (group M, 20 patients for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded. Results: PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients. Conclusion: Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.

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

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    Himanshu A. Shah

    2013-12-01

    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

  19. Focused analgesia in waking and hypnosis: effects on pain, memory, and somatosensory event-related potentials.

    Science.gov (United States)

    De Pascalis, Vilfredo; Cacace, Immacolata; Massicolle, Francesca

    2008-01-01

    Somatosensory event-related potentials (SERPs) to painful electric standard stimuli under an odd-ball paradigm were analyzed in 12 high hypnotizable (HH), 12 medium hypnotizable (MH), and 12 low hypnotizable (LH) subjects during waking, hypnosis, and a cued eyes-open posthypnotic condition. In each of these conditions subjects were suggested to produce an obstructive imagery of stimulus perception as a treatment for pain reduction. A No-Analgesia treatment served as a control in waking and hypnosis conditions. The subjects were required to count the number of delivered target stimuli. HH subjects experienced significant pain and distress reductions during posthypnotic analgesia as compared to hypnotic analgesia and between these two analgesic conditions as compared to the two control conditions. Outside of hypnosis, these subjects remembered less pain and distress levels than they reported during hypnotic and posthypnotic analgesia treatments. In contrast, for waking-analgesia treatment, HH subjects remembered similar pain and distress levels to those they reported concurrently with the stimulation. HH subjects, during hypnotic and posthypnotic analgesia treatments, detected a smaller number of target stimuli and displayed a significant amplitude reduction of the midline frontal and central N140 and P200 SERP components. No significant SERP differences were observed for these subjects between treatments in waking condition and between hypnotic and posthypnotic analgesic treatments. For the MH and LH subjects no significant N140 and P200 amplitude changes were observed among analgesic conditions as compared to control conditions. These amplitude findings are seen as indicating that hypnotic analgesia can affect earlier and later stages of stimulus processing. PMID:18023535

  20. The knowledge and attitudes of nonanesthesia nurses regarding postoperative epidural analgesia.

    Science.gov (United States)

    Sandie, C L; Heindel, L J

    1999-10-01

    The provision of epidural analgesia for postoperative pain control offers many patient benefits and has become commonplace on many nursing units. Since nurses are responsible for the day-to-day management of patients receiving epidural analgesia, their knowledge, attitudes, and practices regarding this technique are pivotal to its success. Therefore, the purpose of the present descriptive study was to examine the knowledge base, attitudes, and clinical practice of registered nurses (N = 85) regarding postoperative epidural analgesia as managed by an acute pain service (APS). Information was obtained from a survey distributed via a convenience sample to all nurses working on 6 units in a large military teaching facility. We developed the "Epidural Knowledge and Attitude Survey" using the nursing literature on epidural analgesia. The survey consisted of a demographics section, true/false (T/F) questions, multiple choice (M/C) questions, an attitude section, and a comment section. These sections addressed the nurses' knowledge, attitudes, and practices in regard to epidural pharmacology, management, and adverse effects, as well as their general satisfaction with the APS of their facility. Data were analyzed statistically using means, standard deviations, percentages, forward step-wise linear regression, the Fisher-Irwin (exact) test, the chi 2 test, and analysis of variance with Bonferroni multiple comparisons. A P value of attitude section illustrated that 73% of nurses had "positive" attitudes toward epidural analgesia. Correct management of patients receiving epidural analgesia was being practiced by 77% of nurses. The satisfaction with the APS at this facility was 32% "very satisfied" and 62% "somewhat satisfied." The demographic characteristics that best predicted a higher score on the knowledge portion of the survey were greater years of practice as a nurse and receipt of pain education in nursing training. Nurses who had received inservice education about

  1. Efeitos do óxido nitroso em hipotensão controlada durante anestesia com baixo fluxo Efectos del óxido nitroso en la hipotensión controlada durante la anestesia con bajo flujo The effects of nitrous oxide on controlled hypotension during low flow anesthesia

    OpenAIRE

    Semiha Barçın; Leyla Sahan; Dilsen Ornek; Fazilet Sahin; Oya Kilci; Serpil Deren; Gulay Erdogan; Canan Un; Mehmet Gamli; Bayazit Dikmen

    2013-01-01

    JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O) em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina) em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1) foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6...

  2. Toracotomia em eqüinos sob anestesia com ventilação mecânica controlada Equine thoracotomy under anesthesia with controlled mechanical ventilation (CMV

    Directory of Open Access Journals (Sweden)

    Raquel Yvonne Arantes Baccarin

    1998-06-01

    Full Text Available Diversos procedimentos cirúrgicos e diagnósticos podem ser realizados através da cirurgia torácica em eqüinos. Para tanto faz-se necessária a utilização da ventilação controlada mecânica (VCM e a compreensão dos efeitos respiratórios deste tipo de ventilação durante a toracotomia. Foram utilizados seis eqüinos hígidos, sob anestesia com ventilação controlada, para a realização de acesso cirúrgico ao hemitórax direito com o objetivo de se avaliar, através da mensuração dos parâmetros fisiológicos, ventigrafia, pH e gases sangüíneos, a eficácia da ventilação controlada em otimizar a ventilação e a oxigenação e em prevenir a atelectasia pulmonar durante manipulações intratorácicas. Verificou-se diminuição dos valores da PaCO2 e aumento dos valores de pH durante a ventilação controlada, mesmo com o pneumotórax instalado. A pressão interpleural também apresentou aumento de seus valores durante a VCM. Concluiu-se que o uso da VCM, durante a prática da toracotomia, permite a padronização da freqüência respiratória com melhora da ventilação, e subseqüente normalização das alterações da pressão parcial de dióxido de carbono e pH, bem como mantém visualmente adequada a expansão pulmonar. A VCM promove aumento da pressão interpleural, enquanto o tórax permanece fechado.Several surgical and diagnostic procedures can be performed on thoracic surgery in the equine. To carry out these procedures controlled mechanical ventilation (CMV is necessary, as well as full understanding of the possible side effects of this type of ventilation. Six healthy equine were used under anesthesia wiith CMV to do right hemithorax approach. The goals were to evaluate efficiency of CMV in the improvement of ventilation and oxigenation as well as in the prevention of pulmonar atelectasis during intrathoracic manipulation. For such evaluation of physiologic parameters measurement, ventigraphy and blood gas analysis

  3. Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

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    Nils Bjerregaard

    2012-01-01

    Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.

  4. The effect of Hegu acupoint stimulation in dental acupuncture analgesia

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    Fransiskus Andrianto

    2007-03-01

    Full Text Available In daily life, dental treatments are often related with oral pain sensation which needs anesthesia procedures. Sometimes local anesthetics can not be used because patients have hypersensitive reaction or systemic diseases which may lead to complications. Stimulating acupoint, such as Hegu activates hypothalamus and pituitary gland to release endogenous opioid peptide substances that reduce pain sensitivity. The aim of the study was to determine Hegu acupoint stimulation effect on the pain sensitivity reduction in maxillary central incisor gingiva. The laboratory experimental research was conducted on 12 healthy male Wistar rats (3 months old, weights 150–200 grams. All rat samples received the same treatments and adapted within 1 month. The research was done in pre and post test control group design. 40-Volt electro-stimulation was done once on the maxillary central incisor gingiva prior to the bilateral Hegu acupoint stimulation, then followed by 3 times electro-stimulation with 3 minutes intervals. The pain scores were obtained based on the samples’ contraction in each electro-stimulation. The responses were categorized into 5 pain scores and statistically analyzed using Wilcoxon Test. The results showed that Hegu acupoint stimulation lowered the pain scores significantly (p < 0.05. Hegu acupoint stimulation could reduce the pain sensitivity in maxillary central incisor gingiva. Therefore, the use of acupuncture analgesia in dental pain management can be considered in the future.

  5. Preventive local analgesia in orthopedic and Traumatology surgery.

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    Hugo Jiménez Vázquez

    2005-11-01

    Full Text Available Fundament: One of the most important aims of modern surgery is the recovery of the ill patients and heir integration to society. Sometimes, this wish has its limitations because of the persistence of pain after surgery. The development of an effective analgesic for after surgery pain is therefore a priority in modern medicine. Objective: To characterize the results obtained with the application of a preventive analgesic by infiltrating without limitations of the use of any other analgesic if necessary. Method: Prospective-descriptive study in a series of 30 patients assisted at the Orthopaedic Service of the ¨Dr. Gustavo Aldereguía Lima¨ Hospital from Cienfuegos province in the period that covers September 2004- march 2005. Anaesthetic infiltration in the surgical area was applied once the surgery was ended . Bupivacaine 0,125 % in a volume of 20 ml and 2 drops of epinephrine without avoiding the use of any other analgesic. Results: a group of 13 patients presented pain in the first 24-48 hours after surgery followed by another group of 9 patients who alleviated pain in the period between 12 and 23 hours after surgery. Conclusions: In this series of patients it was shown the benefits of anaesthetic infiltration in the surgical area with analgesic purposes, since it causes pain alleviation in a period greater than 24 hours. Bupivacaine shows good results since it causes after surgery analgesia and the early application in the rehabilitation of a great number of patients.

  6. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

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    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  7. Augmentation of acetaminophen analgesia by the antihistamine phenyltoloxamine.

    Science.gov (United States)

    Sunshine, A; Zighelboim, I; De Castro, A; Sorrentino, J V; Smith, D S; Bartizek, R D; Olson, N Z

    1989-07-01

    A double-blind, placebo-controlled, parallel-group study was performed to compare the analgesic activity of the combination of 650 mg acetaminophen plus 60 mg phenyltoloxamine citrate with that of 650 mg acetaminophen alone. Two hundred female inpatients who had severe pain associated with a recent episiotomy procedure were randomly assigned to receive a single dose of one of the two active treatments or a placebo. Analgesia was assessed over a 6-hour period. Treatments were compared on the basis of standard subjective scales for pain intensity and relief, a number of derived variables based on these data and two global measures. For essentially all measures, the two active treatments were significantly superior to the placebo control. The combination was significantly superior to acetaminophen alone for all analgesic measures including SPID, TOTAL, and global ratings. The results of this study demonstrate that 60 mg phenyltoloxamine produces significant augmentation of the analgesic activity of 650 mg acetaminophen in postepisiotomy pain. PMID:2569485

  8. The effects of low-dose ketamine on the analgesia nociception index (ANI) measured with the novel PhysioDoloris™ analgesia monitor: a pilot study.

    Science.gov (United States)

    Bollag, Laurent; Ortner, Clemens M; Jelacic, Srdjan; Rivat, Cyril; Landau, Ruth; Richebé, Philippe

    2015-04-01

    The PhysioDoloris™ analgesia monitor assesses nociception effects on the autonomic nervous system by analyzing changes in heart rate variability (HRV). This non-invasive device analyses ECG signals and determines the analgesia nociception index (ANI), allowing for quantitative assessment of the analgesia/nociception balance in anesthetized patients. Ketamine, an analgesic adjuvant with sympathomimetic properties, has been shown to improve perioperative pain management. The purpose of this pilot study was to evaluate whether low-dose ketamine, due to its intrinsic effect on the sino-atrial node, affects HRV and, therefore, interferes with ANI measurements. This pilot study included 20 women undergoing abdominal hysterectomies. Anesthesia and analgesia were maintained with sevoflurane and fentanyl respectively, in a standardized manner. Five minutes after intubation, 0.5 μg kg(-1) of intravenous (i.v.) ketamine was administered. ANI, bispectral index (BIS), heart rate and blood pressure were recorded from the induction of anesthesia until 5 min after skin incision. There was not any significant decrease in mean (±SD) ANI values after intubation (2.11±20.11, p=0.35) or i.v. ketamine administration (1.31±15.26, p=0.28). The mean (±SD) reduction in ANI values after skin incision was statistically significant (13.65±15.44, p=0.01), which is consistent with increased nociception. A single i.v. bolus of 0.5 μg kg(-1) ketamine did not influence the ANI values of 20 women under standardized general anesthesia conditions and absent noxious stimulation. These results suggest that the ANI derived from the PhysioDoloris™ analgesia monitor is feasible under such clinical conditions. PMID:25062948

  9. [The modulation of cerebral cortex and subcortical nuclei on NRM and their role in acupuncture analgesia].

    Science.gov (United States)

    Liu, X

    1996-01-01

    The vast research have demonstrated that the acupuncture analgesia is effected through a physiological mechanism brought about by the nervous system, particularly the central nervous system. We combined the acupuncture effects and theory of channels and collaterals with the new advance of pain neurophysiology, and centred attention on nucleus raphe magnus (NRM), that is one of the origins of the important descending inhibitory pathways of the intrinsic analgesic systems in brain. The unit discharges of NRM neurons and their nociceptors/ph responses were recorded extracellularly with glass microelectrode at 1495 neurons on 634 wastar rats. The modulation of cerebral cortex, the head of N. caudatum (NCa), N. Accumbens (N. Ac), N lateral habenular (NHa) and Periaquaeductal gray matter (PAG) on NRM and their role in acupuncture analgesia were studied by central locational stimulation, lesion and microinjection. The result were as follows: 1. The most NRM neurons could respond to noxious stimulation of tail tip with increasing or decreasing firing rate. Electroacupuncture (EA) at "Zusanli" could activate the NRM neuron, increasing discharges, and inhibit their nociceptive responses, producing analgesia. 2. The activity of NRM neuron was modulated by PAG, NAc, and NCa. Stimulation at one of them can activate neuron of NRM, increasing firing rate, and induce analgesia. When the lesion or microinjection naloxone were made in PAG, NAc or NCa, EA analgesia could be weakened or lost, even the nociceptive responses might be increased. It is suggest that the nuclei participated in EA analgesia with their endogenous opiate like substance, and were playing an important role. It is also indicated that the electroacupuncture was used on the patients with some nuclei lesion or pathological changes should be careful to avoid making patients feel more painful. 3. Somatosensory area II (Sm II) of cerebral cortex participated in EA analgesia. The analgesic effects of EA at "Zusanli

  10. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

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    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

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

    Science.gov (United States)

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

    2011-07-01

    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

  12. Effects of Flurbiprofen Axetil on Postoperative Analgesia and Cytokines in Peripheral Blood of Thoracotomy Patients.

    Science.gov (United States)

    Zhou, Mi; Li, Beiping; Kong, Ming

    2015-06-01

    The objective is to study the effects of flurbiprofen axetil (FA) with fentanyl together in postoperative controlled intravenous analgesia (PCIA) on pain intensity, cytokine levels in peripheral blood and adverse reactions of thoracotomy patients. Fifty thoracotomy patients were divided into a FA and a control group, each with 25 cases. Postoperative analgesia was administered in the two groups using PCIA. The pressing times of analgesia pump, the visual analog scale (VAS) scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery and the incidence of adverse drug reactions were recorded. Levels of IL-1β, IL-6, IL-8, IL-2, and TNF-α in peripheral blood were determined before the administration of FA (T0), and at 24 h (T1), 48 h (T2), 72 h (T3) after surgery. The analgesia pump pressing times in the FA group was less than that of the control group. The VAS scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery, were statistically less than those of control group. The incidence rate of nausea and vomiting was insignificantly different between the two groups. Administration of FA together with PCIA in thoracotomy patients can improve postoperative analgesia.

  13. Combined spinal-epidural analgesia in labour: its effects on delivery outcome

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    Suneet Kaur Sra Charanjit Singh

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

  14. Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho Estudio comparativo de la analgesia entre bupivacaína y morfina intra-articular en osteoartritis de la rodilla Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

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    Miriam C B Gazi

    2005-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A osteoartrite é a mais freqüente entre as doenças articulares em pessoas idosas. O objetivo do estudo foi comparar o efeito analgésico da bupivacaína e da morfina por via intra-articular em pacientes portadores de osteoartrite de joelho. MÉTODO: Foram avaliados 39 pacientes em estudo duplamente encoberto, divididos de forma aleatória, em dois grupos: os do G1 (n = 18 receberam 1 mg (1 mL de morfina diluída em 9 mL de solução fisiológica a 0,9% e os do G2 (n = 21, 25 mg (10 mL de bupivacaína a 0,25% sem vasoconstritor, por via intra-articular. A intensidade da dor foi avaliada pela escala numérica e verbal nos momentos 0, 30, 60 minutos e 7 dias, em repouso e em movimento. Foram avaliados a necessidade de complementação analgésica com paracetamol (500 mg, a dose total de analgésico utilizado, a duração da analgesia e a qualidade da analgesia (pelo paciente. RESULTADOS: Dos 39 pacientes, 31 completaram o estudo. Não houve diferença significativa da intensidade da dor em repouso e em movimento entre os dois grupos nos momentos estudados. Não houve diferença entre os dois grupos no tempo entre a administração da solução e a necessidade de complementação analgésica. A dose média do paracetamol utilizada no primeiro dia da semana foi de 796 mg do G1 e de 950 mg no G2; a complementação na semana foi de 3578 mg no G1 e 5333 mg no G2. CONCLUSÕES: O efeito analgésico de 1 mg de morfina e de 25 mg de bupivacaína a 0,25% sem vasoconstritor intra-articular foram semelhantes.JUSTIFICATIVA Y OBJETIVOS: La osteoartritis es la más frecuente entre las enfermedades articulares en personas de edad. El objetivo del estudio fue comparar el efecto analgésico de la bupivacaína y de la morfina por vía intra-articular en pacientes portadores de osteoartritis de rodilla. MÉTODO: Fueron evaluados 39 pacientes en estudio doblemente encubierto, divididos de forma aleatoria, en dos grupos: los del G1 (n = 18

  15. Post operatory analgesia in caesarean surgery. Analgesia posoperatoria en la operación cesárea.

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    Rolando T. Espín González

    Full Text Available Background: Post-operatory pain is a spread and constant problem during the care of the surgical patient. The tendency to find new therapeutic techniques to alleviate pain has lead scientists to make and use a great variety of analgesics which are administered by different vias. The effects of narcotics on the new born are well known and the author´s worries about this problem has been the motivational point to search about the use of epidural and intratecal narcotics in the obstetric patient. Objective: To assess the use of peridural liophilized morphine in the Caesarean Section Method: A study of a series of cases was carried out at the Surgical Unit of the Gynecobstetric service of the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ from February 2001 to August 2002 . This search included 120 patient who were selected to elective iterative caesarean section The variables under study were blood pressure, pulse and respiration during the pre- trans and post operative phases, onset of the anaesthetic effect and its duration, peri operatory complications , quality of the post operatory analgesia and its effect on the newborn measured by using Apgar values . The statistical procedure was developed by using the statistical package Epi Info 6. Results: The onset of the anesthetic effect and the duration of the anesthesia were not modified with the use of liophilized morphine. Vital signs remained within normal limits in most of the patients during the pre- trans and post operatory phases. The complications were: pruritus, urinary retention, nausea nad vomiting. The quality of the analgesia was satisfactory in most of the patients. The Apgar values were normal in all neonates. Conclusion: The administration of peridural liophilized morphine in elective caesarean sections is a reliable, sure and useful method in our environment.

  16. Tratamento da criptococose do sistema nervoso pelo Amphotericin B

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    Dante Giorgi

    1959-12-01

    Full Text Available Os autores descrevem a evolução dos conhecimentos sôbre a meningoen-cefalite produzida pelo Criptococcus neoformans, analisando as dificuldades anteriormente havidas para o diagnóstico em vida, as quais foram superadas depois que se usou rotineiramente a pesquisa do cogumelo no LCR pelo método de coloração de tinta da China e pela cultura. Assinalam, a seguir, o aparecimento do Amphotericin B, novo antibiótico fungicida que veio modificar o prognóstico desta afecção. Apresentam sua experiência com 14 casos de meningite por criptococos diagnosticados em vida e referem pormenorizadamente 2 casos tratados com o Amphotericin B. O primeiro, de paciente portadora desta afecção, evoluindo de maneira crônica, com períodos de exacerbação que melhoram nitidamente com o Amphotericin B e que está com uma sobrevida de 20 meses. O segundo, de paciente portadora de forma aguda desta afecção que teve cura clínica e está com LCR absolutamente normal, com seguimento de 11 meses. Em ambos os casos foi usada a via endovenosa, sendo feitas séries de 10 injeções, cada uma de 50 mg de Amphotericin B em 500 ml de sôro glicosado a 5%. No primeiro caso foram feitas 4 séries e no segundo apenas duas. Não foram registradas reações colaterais de importância. Os autores terminam considerando o Amphotericin B como um elemento que veio tornar muito mais favorável o prognóstico desta afecção até então mortal.

  17. Analgesia epidural com clonidina ou romifidina em cães submetidos à cirurgia coxofemoral Epidural analgesia with clonidine or romifidine in dogs submitted to coxofemoral surgery

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    J.T. Brondani

    2004-04-01

    Full Text Available Avaliaram-se as alterações cardiorrespiratórias e a analgesia da administração epidural de clonidina ou romifidina em cães submetidos à cirurgia coxofemural. Foram utilizados 14 cães distribuídos em dois grupos: o grupo Cloni recebeu 150µg de clonidina e o grupo Romi, 20µg/kg de romifidina. A indução anestésica foi realizada com propofol e a anestesia cirúrgica mantida com halotano e O2 em respiração espontânea. A punção do espaço epidural foi feita logo após a indução. Antes da indução e a cada 10 minutos foram avaliadas as freqüências cardíaca e respiratória, a pressão arterial sistólica, a saturação de oxigênio da hemoglobina e a concentração de halotano. Após indução e ao término do procedimento cirúrgico coletou-se sangue arterial para avaliação gasométrica de pH, PaCO2, PaO2, SaO2, BE e HCO3-. Foi realizada avaliação pós-operatória do grau de analgesia (intensa, pouco intensa e inadequada nas primeiras duas horas após término da cirurgia. Os animais do grupo Romi apresentaram bradicardia, bradiarritmias e hipertensão. A freqüência cardíaca e a pressão arterial sistólica no grupo Cloni mantiveram-se dentro da faixa de variação fisiológica para a espécie. A analgesia trans-operatória foi considerada intensa nos dois grupos. A administração epidural de clonidina ou romifidina produziu intensa analgesia transcirúrgica sem depressão respiratória e pouco intensa analgesia pós-operatória por duas horasCardiovascular alterations and analgesia in 14 dogs submitted to epidural administration of clonidine or romifidine to enable coxofemoral surgery were evaluated. Dogs were separated in two groups: Cloni group received 150µg of clonidine and Romi group, 20µg/kg of romifidine. Anesthetic induction was performed using propofol (8mg/kg and maintenance using halothane and O2 in spontaneous breathing. The puncture of epidural space was performed just after anesthetic induction. Heart

  18. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five-...

  19. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

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    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  20. Local infiltration analgesia in urogenital prolapse surgery: a prospective randomized, double-blind, placebo-controlled study

    DEFF Research Database (Denmark)

    Kristensen, Billy B; Rasmussen, Yvonne H; Agerlin, Marianne;

    2011-01-01

    To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique.......To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique....

  1. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.

    NARCIS (Netherlands)

    Galvin, E.; Boesjes, H.; Hol, J.; Ubben, J.F.; Klein-Nulend, J.; Verbrugge, S.J.

    2010-01-01

    BACKGROUND: Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. METHODS: Patients scheduled for extraco

  2. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

    Directory of Open Access Journals (Sweden)

    Patrícia Falcão Pitombo

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI e grupo seletivo (GS, sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.JUSTIFICATIVA Y OBJETIVOS: Las cirugías artroscópicas del hombro cursan con un intenso dolor postoperatorio. Diversas técnicas analgésicas han sido preconizadas

  3. Comparison of tapentadol with tramadol for analgesia after cardiac surgery

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    Srinivas Kalyanaraman Iyer

    2015-01-01

    Full Text Available Background: Tapentadol is a relatively new analgesic. We decided to compare it with tramadol for their various effects after cardiac surgery. Setting: A study in a tertiary care hospital. Materials and Methods: Sixty adults undergoing cardiac surgery were divided into 2 groups of 30 each by computerized random allotment (Group X = tapentadol 50 mg oral and Group Y = tramadol 100 mg oral. Informed Consent and Institutional Ethics Committee approval were obtained. The patients were given either drug X or drug Y after extubation in this single blinded study, wherein the data collectors and analyzers were blinded to the study. All patients received oral paracetamol qds and either drug X or drug Y tds. The pain score was noted on a Visual Analog Scale before each drug dose, 3 h later and on coughing. Heart rate, respiratory rate, and blood pressure were recorded before the drug dose and 3 h later. Postoperative nausea or vomiting (PONV, temperature, and modified Glasgow Coma Scale readings were recorded. The above readings were obtained for 6 doses (up to 48 h after extubation. Statistics: t-test, Pearson Chi-square test, Fisher exact test, and Mantel-Haenszel test were used for statistics. Results: Tapentadol group patients had significantly better analgesia 3 h after the drug and "on coughing" than tramadol group. The difference in their effects on blood creatinine levels, temperature, hemodynamics, oxygen saturation, and respiratory rate were not clinically significant. Tapentadol produced lesser drowsiness and lesser vomiting than tramadol. Conclusions: Tapentadol, due to its norepinephrine reuptake inhibition properties, in addition to mu agonist, is a better analgesic than tramadol and has lesser PONV.

  4. Effects of regional analgesia on stress responses to pediatric surgery.

    Science.gov (United States)

    Wolf, Andrew R

    2012-01-01

    Invasive surgery induces a combination of local response to tissue injury and generalized activation of systemic metabolic and hormonal pathways via afferent nerve pathways and the central nervous system. The local inflammatory responses and the parallel neurohumoral responses are not isolated but linked through complex signaling networks, some of which remain poorly understood. The magnitude of the response is broadly related to the site of injury (greater in regions with visceral pain afferents such as abdomen and thorax) and the extent of the trauma. The changes include alterations in metabolic, hormonal, inflammatory, and immune systems that can be collectively termed the stress response. Integral to the stress responses are the effects of nociceptive afferent stimuli on systemic and pulmonary vascular resistance, heart rate, and blood pressure, which are a combination of efferent autonomic response and catecholamine release via the adrenal medulla. Therefore, pain responses, cardiovascular responses, and stress responses need to be considered as different aspects of a combined bodily reaction to surgery and trauma. It is important at the outset to understand that not all components of the stress response are suppressed together and that this is important when discussing different analgesic modalities (i.e. opioids vs regional anesthesia). For example, in terms of the use of fentanyl in the infant, the dose required to provide analgesia (1-5 mcg·kg(-1)) is less than that required for hemodynamic stability in response to stimuli (5-10 mcg·kg(-1)) (1) and that this in turn is less than that required to suppress most aspects of the stress response (25-50 mcg·kg(-1)) (2). In contrast to this considerable dose dependency, central local anesthetic blocks allow blockade of the afferent and efferent sympathetic pathways at relatively low doses resulting in profound suppression of hemodynamic and stress responses to surgery. PMID:21999144

  5. RELATIONSHIP BETWEEN ACUPUNCTURE ANALGESIA AND MET- ENKEPHALIN OR DYNORPHIN

    Institute of Scientific and Technical Information of China (English)

    TsogoevAlanS; 王一菱; 吴景兰; 金辉

    2001-01-01

    subjective: The effect of 4~5 Hz electroacupuncture (EA) on alterations of both met-enkephalin (MEK) and dynorphin (Dyn) in the patient plasma or mouse spinal cord and its relation with analgesic effect were studied. Methods: In acupuncture clinic 10 patients with acute pain were treated with 4 Hz EA at Zusanli(ST 36) and/or Hegu(LI 4) acupoints for 30 min. 20 BALB/C mice were randomly divided into 2 groups: a. EA group(n=10), treated with 4~5 Hz EA at bilateral "Zusanli"(ST 36) for 15 min; b. control group(n=10) treated with no EA, but also restrained for 15 min. Before and after EA or restraining acupoints, the pain threshold of the patients or mice was detected. 10 μI of the patient plasma before and after EA and each mouse spinal cord suspension, of the 2 groups were blotted onto nitrocellulose membrane (NCM) respectively. The protein dot blot signals were detected by immunoreactivity (IR) and using Shimadu TLC Scanner and analyzed statistically. Results: The results showed that an increase in patient plasma MEK-IR or Dyn-IR and a decrease in mouse spinal MEK-IR or Dyn-IR could be detected, and the alteration of plasma or spinal MEK-IR was more significant than that of plasma or spinal Dyn-IR. There was a positive correlation in alteration between plasma or spinal MEK-IR and plasma or spinal Dyn-IR with respective parallel levels in individuals. The increased plasma MEK-IR or the decreased spinal MEK-IR was positively or negatively correlated with the analgesic effect, while the correlation between plasma or spinal Dyn-IR and analgesic effect was insignificant. Conclusion: The results suggest that under lower frequency EA the met-enkephalin may play an important role in analgesia.

  6. Endogenous opiate analgesia induced by tonic immobility in guinea pigs

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    C.R.A. Leite-Panissi

    2001-02-01

    Full Text Available A function of the endogenous analgesic system is to prevent recuperative behaviors generated by tissue damage, thus preventing the emission of species-specific defensive behaviors. Activation of intrinsic nociception is fundamental for the maintenance of the behavioral strategy adopted. Tonic immobility (TI is an inborn defensive behavior characterized by a temporary state of profound and reversible motor inhibition elicited by some forms of physical restraint. We studied the effect of TI behavior on nociception produced by the formalin and hot-plate tests in guinea pigs. The induction of TI produced a significant decrease in the number of flinches (18 ± 6 and 2 ± 1 in phases 1 and 2 and lickings (6 ± 2 and 1 ± 1 in phases 1 and 2 in the formalin test when compared with control (75 ± 13 and 22 ± 6 flinches in phases 1 and 2; 28 ± 7 and 17 ± 7 lickings in phases 1 and 2. In the hot-plate test our results also showed antinociceptive effects of TI, with an increase in the index of analgesia 30 and 45 min after the induction of TI (0.67 ± 0.1 and 0.53 ± 0.13, respectively when compared with control (-0.10 ± 0.08 at 30 min and -0.09 ± 0.09 at 45 min. These effects were reversed by pretreatment with naloxone (1 mg/kg, ip, suggesting that the hypoalgesia observed after induction of TI behavior, as evaluated by the algesimetric formalin and hot-plate tests, is due to activation of endogenous analgesic mechanisms involving opioid synapses.

  7. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg;

    on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour......Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour......, and reduce fear during birth which in turn may decrease use of pain relief. Few randomised trials have examined the effect of attending antenatal education in small groups on use of epidural analgesia and among these conclusions are conflicting. The objective of this study was therefore to examine the effect...

  8. Effect of Age, Adernaline and Operation Site on Duration of Caudal Analgesia in Paediatric Patients

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    Kharirat Mohd., Yasir,G.A.Mir

    2003-04-01

    Full Text Available The effect ofage, operative site and addition of 1: 200,000 adrenaline to bupivacaine was evaluatedon the duration ofpost operative analgesia after caudal block in 200 children between the age groupof 1 year to 14 years. Anaesthesia was induced and maintained on Halothane/N20I02• After thiscaudal block was performed with 0.5 mllkg of0.25% bupivacaine in one group of 100 Children andwith 0.25% bupivacaine with adrenaline 1 : 200,000 in another 100 children. The duration of postoperative analgesia was noted to be significantly longer in young children, in children having penoscrotaloperations and when adrenaline was added to bupivacaine. Conclusion was drawn that durationofpost-operative analgesia depended upon age, site and addition of adrenaline to bupivacaine.

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

    Science.gov (United States)

    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

    2015-01-01

    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

  10. Understanding Central Mechanisms of Acupuncture Analgesia Using Dynamic Quantitative Sensory Testing: A Review

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    Jiang-Ti Kong

    2013-01-01

    Full Text Available We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS and conditioned pain modulation (CPM are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.

  11. Inhibiting spinal neuron-astrocytic activation correlates with synergistic analgesia of dexmedetomidine and ropivacaine.

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    Huang-Hui Wu

    Full Text Available BACKGROUND: This study aims to identify that intrathecal (i.t. injection of dexmedetomidine (Dex and ropivacaine (Ropi induces synergistic analgesia on chronic inflammatory pain and is accompanied with corresponding "neuron-astrocytic" alterations. METHODS: Male, adult Sprague-Dawley rats were randomly divided into sham, control and i.t. medication groups. The analgesia profiles of i.t. Dex, Ropi, and their combination detected by Hargreaves heat test were investigated on the subcutaneous (s.c. injection of complete Freund adjuvant (CFA induced chronic pain in rat and their synergistic analgesia was confirmed by using isobolographic analysis. During consecutive daily administration, pain behavior was daily recorded, and immunohistochemical staining was applied to investigate the number of Fos-immunoreactive (Fos-ir neurons on hour 2 and day 1, 3 and 7, and the expression of glial fibrillary acidic protein (GFAP within the spinal dorsal horn (SDH on day 1, 3, 5 and 7 after s.c. injection of CFA, respectively, and then Western blot to examine spinal GFAP and β-actin levels on day 3 and 7. RESULTS: i.t. Dex or Ropi displayed a short-term analgesia in a dose-dependent manner, and consecutive daily administrations of their combination showed synergistic analgesia and remarkably down-regulated neuronal and astrocytic activations indicated by decreases in the number of Fos-ir neurons and the GFAP expression within the SDH, respectively. CONCLUSION: i.t. co-delivery of Dex and Ropi shows synergistic analgesia on the chronic inflammatory pain, in which spinal "neuron-astrocytic activation" mechanism may play an important role.

  12. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico

    Directory of Open Access Journals (Sweden)

    Patrícia Falcão Pitombo

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI e grupo seletivo (GS, sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.

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

    DEFF Research Database (Denmark)

    Kehlet, H; Andersen, L Ø

    2011-01-01

    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...... multimodal, non-opioid analgesia together with organisational optimisation of care according to the fast-track methodology....... administration. In knee replacement, a compression bandage prolongs the analgesic effect. There are limited data to support the use of NSAIDs or epinephrine in the solution and the data on post-operative hospitalisation and recovery are conflicting. Thus, shorter lengths of stay have been achieved by oral...

  14. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    were selected for inclusion in the review. In THA, no additional analgesic effect of LIA compared with placebo was reported in trials with low risk of bias when a multimodal analgesic regimen was administered perioperatively. Compared with intrathecal morphine and epidural analgesia, LIA was reported...... to have similar or improved analgesic efficacy. In TKA, most trials reported reduced pain and reduced opioid requirements with LIA compared with a control group treated with placebo/no injection. Compared with femoral nerve block, epidural or intrathecal morphine LIA provided similar or improved analgesia...

  15. Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders

    Directory of Open Access Journals (Sweden)

    Todd J. Kilbaugh

    2010-01-01

    Full Text Available Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy. The overall objectives of this paper are (1 to provide an overview on recent studies that highlight the increased risk for respiratory complications following sedation and analgesia in children with developmental disabilities and neurologic disorders, (2 to provide a better understanding of sedatives and analgesic medications which are commonly used in children with developmental disabilities and neurologic disorders on the central nervous system.

  16. Analgesia quirúrgica acupuntural:estudio de la efectividad de dos técnicas

    OpenAIRE

    Pagola Bérger, Victor Valentín

    2008-01-01

    Se presenta el estudio de la efectividad de la aplicación de la acupuntura a la realización de operaciones de cirugía mayor durante 14 años en Villa Clara. Se exponen los resultados de 2582 operados con Analgesia Quirúrgica Acupuntural clásica y 236 intervenciones previa Implantación de Catgut. Para la evaluación de la efectividad de la primera, realizada entre 1992 y 2006, se definieron como resultados esperados: la analgesia transoperatoria, calificada de Bien en el 94% de los operados y la...

  17. Manejo de la analgesia postoperatoria en las primeras 24 horas en un Hospital de segundo nivel: Estudio observacional Postoperative analgesia treatment during the first 24 hours in a second level hospital.

    Directory of Open Access Journals (Sweden)

    D. L. Fernández

    2006-01-01

    Full Text Available Objetivo: Evaluar el cumplimiento y eficacia de la medicación analgésica no protocolizada y utilizada en un hospital de segundo nivel en las 24 h posteriores a cirugía, donde la intensidad del dolor está catalogada como moderada severa. Método: Estudio prospectivo y observacional. Se incluyeron 119 pacientes mayores de 18 años, intervenidos de cirugía traumatológica: prótesis total de cadera, rodilla, artrodesis vertebral, cirugía de hombro y laparotomías. Ante la falta de protocolos, la medicación analgésica postoperatoria de base y de rescate fue prescrita según criterio del anestesiólogo responsable. La administración de cloruro mórfico y el empleo de los dispositivos de administración: catéteres peridurales, PCA (analgesia controlada por el paciente quedaron restringidos a la unidad de recuperación anestésica (URPA y al área crítica. En planta de hospitalización los opiáceos prescritos fueron la meperidina por vía intramuscular y el tramadol endovenoso. Los opiáceos siempre se asociaron a analgésicos parenterales como metamizol, diclofenaco o paracetamol Se valoró la intensidad del dolor (VAS 0-100 mm y escala verbal EV 1-4 24 h después de la cirugía (24 y se registró la máxima intensidad de dolor percibida en el primer día de postoperatorio (Max. Se consideró el porcentaje de pacientes con dolor no controlado (DNC: VAS >30 y EV >2 para los momentos 24 y Max. Se consignaron las dosis de fármacos analgésicos de base y rescate, prescritos y consumidos. Para cada analgésico prescrito como base, se calculó la diferencia porcentual entre la dosis media prescrita y la dosis media consumida, indicador que se denominó grado de cumplimiento (GC. Resultados: Intensidad de dolor 24: VAS 27.8 ± 22.6, EV 2; porcentaje de pacientes con DNC según VAS /EV: 36.1/ 42.8%, respectivamente. Max: VAS 58.4 ± 28.9, EV 4; DNC según VAS/EV : 79.8 / 82.3 %, respectivamente. Prescripción de opiáceos (Nº pacientes, X ± DE

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

    OpenAIRE

    Shah, Himanshu A; Jaishree S. B.; Mrugank Bhavsar

    2013-01-01

    Background: Accurate management of post operative pain is quite impossible with single drug therapy approach. For this, our aim was to combine use of tapentadol tablet orally along with thoracic epidural in comparison with intravenous combined use of tramadol, paracetamol and diclofenac for postoperative analgesia in case CABG patients. Methods: 60 patients of CABG (Coronary Artery Bypass Surgery) randomly and equally divided into two groups. Group TTE (Tab. Tapentadol -Thoracic Epidural, ...

  19. Analgesia in patients with acute abdomen: does danger persist? Analgesia en el paciente con abdomen agudo: ¿persiste el peligro?

    OpenAIRE

    Juan Camilo Correa Gallego; Edward Alexander Blandón Castaño

    2006-01-01

    INTRODUCTION: Acute abdominal pain is a very frequent cause of medical consultation. Early analgesia is not usually given to patients that present with it as their chief complaint, because of the many differential diagnoses that must be taken into consideration and also because of fear of the potential complications that may ensue if an early and accurate diagnosis is not made. Nowadays medical practice is evolving and it is pertinent to ask and answer whether it is still adequate to keep the...

  20. Maternal Expectations and Experiences of Labor Analgesia With Nitrous Oxide

    Science.gov (United States)

    Pasha, Hajar; Basirat, Zahra; Hajahmadi, Mahmood; Bakhtiari, Afsaneh; Faramarzi, Mahbobeh; Salmalian, Hajar

    2012-01-01

    Background Although there are various methods for painless delivery such as using entonox gas, most of the people are unfamiliar or concerned about it yet. Objectives The purpose of this study was to assess maternal expectations and experience of labor analgesia with nitrous oxide. Patients and Methods In a clinical trial study, 98 pregnant women in active phase of delivery were studied randomly in two groups (intervention group = 49, control group = 49) after obtaining written consent. Efficacy, experience satisfaction, and also expectation of pregnant women about entonox gas in two groups were compared, likewise in intervention group before and after using entonox gas. Results Most of the pregnant women receiving entonox gas had less labor pain (91.8%), and were satisfied with it (98%). The severity of pain in the most of entonox user was moderate level (46.94%), while for the control group it was severe (55.10%) which was significant, 40.82% of the mother in entonox group had a severe pain and 10.20% had a very severe pain, whereas in the control group (55.10%) of the mother had a severe pain and 26.53% of the had very severe pain (P = 0.004). efficacy of labor pain was in moderate level in most cases. 49% of pregnant women receiving gas described their experience as a good and excellent. 80.9% indicated that they will request the mentioned painless method in the future. The amount of suffering from gas side effects was mild in most patients of intervention group (63%). Expectations of the majority of pregnant women in intervention group (before receiving gas) and control group for painless delivery were weak (65.3%, 40.9%). The percentage of positive expectations had increased after receiving entonox gas (P = 0.01). There was a difference between the expectations of intervention group receiving entonox gas and control group (P = 0.001). Positive expectations were more in intervention group than the control group. Most differences of expectations in intervention

  1. Concepção de uma instalação frigorífica com atmosfera controlada para a conservação de uvas de mesa

    OpenAIRE

    Beites, Rui Pedro Leitão

    2013-01-01

    Este Trabalho Final de Mestrado consiste na concepção de uma instalação frigorífica com atmosfera controlada com o objectivo de armazenar uvas de mesa. Em primeiro lugar estudou-se os factores que influenciam na concepção da instalação, quer a nível interno e externo. Também foi feito um estudo do produto, como o seu processo de amadurecimento, a sua respiração, e produção de etileno, factores fundamentais em atmosfera controlada. De seguida foi dimensionada a instalação, com atenção ao...

  2. Padrão de ocorrência de doenças em mamão armazenado sob atmosfera controlada Evolution of postharves diseases on papaya storaged under controlled atmosphere

    OpenAIRE

    Marcos José de Oliveira Fonseca; Nilton Rocha Leal; Sérgio Agostinho Cenci

    2004-01-01

    O objetivo deste trabalho foi avaliar a dinâmica de evolução de doenças pós-colheita do mamão armazenado sob atmosfera controlada, contendo 3,0% de O2 e 6,0% de CO2 ou 3,0% de O2 e 3,0% de CO2, em relação aos armazenados sob atmosfera ambiente, na simulação de condições de exportação refrigerada (10ºC) via marítima, e de comercialização no mercado europeu dos mamões 'Sunrise Solo' e 'Golden'. Constatou-se que a atmosfera controlada contendo 3% de O2 e 6% de CO2 promoveu maior perda de frutos,...

  3. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

    Directory of Open Access Journals (Sweden)

    Neha Baduni

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM, and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

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

    DEFF Research Database (Denmark)

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

    2005-01-01

    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...

  5. Opioid-Induced Glial Activation: Mechanisms of Activation and Implications for Opioid Analgesia, Dependence, and Reward

    Directory of Open Access Journals (Sweden)

    Mark R. Hutchinson

    2007-01-01

    Full Text Available This review will introduce the concept of toll-like receptor (TLR–mediated glial activation as central to all of the following: neuropathic pain, compromised acute opioid analgesia, and unwanted opioid side effects (tolerance, dependence, and reward. Attenuation of glial activation has previously been demonstrated both to alleviate exaggerated pain states induced by experimental pain models and to reduce the development of opioid tolerance. Here we demonstrate that selective acute antagonism of TLR4 results in reversal of neuropathic pain as well as potentiation of opioid analgesia. Attenuating central nervous system glial activation was also found to reduce the development of opioid dependence, and opioid reward at a behavioral (conditioned place preference and neurochemical (nucleus accumbens microdialysis of morphine-induced elevations in dopamine level of analysis. Moreover, a novel antagonism of TLR4 by (+- and (˗-isomer opioid antagonists has now been characterized, and both antiallodynic and morphine analgesia potentiating activity shown. Opioid agonists were found to also possess TLR4 agonistic activity, predictive of glial activation. Targeting glial activation is a novel and as yet clinically unexploited method for treatment of neuropathic pain. Moreover, these data indicate that attenuation of glial activation, by general or selective TLR antagonistic mechanisms, may also be a clinical method for separating the beneficial (analgesia and unwanted (tolerance, dependence, and reward actions of opioids, thereby improving the safety and efficacy of their use.

  6. Opioid therapy : a trade-off between opioid-analgesia and opioid-induced respiratory depression

    NARCIS (Netherlands)

    Boom, Maria Catharina Anna

    2013-01-01

    Conclusions that may be drawn from the data in this thesis: 1. The ideal drug for antagonism of respiratory depression has not yet been found. At present naloxone seems the most appropriate drug although reversal of respiratory depression coincides with loss of analgesia. New reversal agents acting

  7. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.; Bakker, S.; Heesterbeek, P.; Van Den Bemt, B.; Scheffer, G.J.; Touw, D.; Stienstra, R.

    2016-01-01

    Background and Aims: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unb

  8. Activation of the opioidergic descending pain control system underlies placebo analgesia.

    Science.gov (United States)

    Eippert, Falk; Bingel, Ulrike; Schoell, Eszter D; Yacubian, Juliana; Klinger, Regine; Lorenz, Jürgen; Büchel, Christian

    2009-08-27

    Placebo analgesia involves the endogenous opioid system, as administration of the opioid antagonist naloxone decreases placebo analgesia. To investigate the opioidergic mechanisms that underlie placebo analgesia, we combined naloxone administration with functional magnetic resonance imaging. Naloxone reduced both behavioral and neural placebo effects as well as placebo-induced responses in pain-modulatory cortical structures, such as the rostral anterior cingulate cortex (rACC). In a brainstem-specific analysis, we observed a similar naloxone modulation of placebo-induced responses in key structures of the descending pain control system, including the hypothalamus, the periaqueductal gray (PAG), and the rostral ventromedial medulla (RVM). Most importantly, naloxone abolished placebo-induced coupling between rACC and PAG, which predicted both neural and behavioral placebo effects as well as activation of the RVM. These findings show that opioidergic signaling in pain-modulating areas and the projections to downstream effectors of the descending pain control system are crucially important for placebo analgesia. PMID:19709634

  9. Mechanisms of placebo analgesia: rACC recruitment of a subcortical antinociceptive network.

    Science.gov (United States)

    Bingel, U; Lorenz, J; Schoell, E; Weiller, C; Büchel, C

    2006-01-01

    Placebo analgesia is one of the most striking examples of the cognitive modulation of pain perception and the underlying mechanisms are finally beginning to be understood. According to pharmacological studies, the endogenous opioid system is essential for placebo analgesia. Recent functional imaging data provides evidence that the rostral anterior cingulate cortex (rACC) represents a crucial cortical area for this type of endogenous pain control. We therefore hypothesized that placebo analgesia recruits other brain areas outside the rACC and that interactions of the rACC with these brain areas mediate opioid-dependent endogenous antinociception as part of a top-down mechanism. Nineteen healthy subjects received and rated painful laser stimuli to the dorsum of both hands, one of them treated with a fake analgesic cream (placebo). Painful stimulation was preceded by an auditory cue, indicating the side of the next laser stimulation. BOLD-responses to the painful laser-stimulation during the placebo and no-placebo condition were assessed using event-related fMRI. After having confirmed placebo related activity in the rACC, a connectivity analysis identified placebo dependent contributions of rACC activity with bilateral amygdalae and the periaqueductal gray (PAG). This finding supports the view that placebo analgesia depends on the enhanced functional connectivity of the rACC with subcortical brain structures that are crucial for conditioned learning and descending inhibition of nociception. PMID:16364549

  10. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  11. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  12. Effect of preemptive analgesia with parecoxib sodium on the postoperative pain for gynecological laparoscopy

    Institute of Scientific and Technical Information of China (English)

    Yu-Jing Zhou

    2015-01-01

    Objective:To observe the effect of preemptive analgesia with parecoxib sodium on the postoperative pain and complications for patients undergoing gynecological laparoscopy. Methods:A total of 100 patients with ASA I-II grade who were admitted in our hospital from January, 2013 to February, 2014 and were undergoing gynecological laparoscopy were included in the study and randomized into the observation group and the control group. The patients in the observation group were given parecoxib sodium injection (40 mg) 30 min before operation and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery, while the patients in the control group were givens injections of parecoxib sodium injection (40 mg) and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery. The analgesia and sedation effects 4, 8, 12 h after the operation in the two groups were observed, and the postoperative additional fentanyl dosage and the adverse reactions were recorded.Results: The postoperative VAS score in each timing point and the total dosage of fentanyl in the observation group were significantly lower than those in the control group (P0.05).Conclusions: The preemptive analgesia with parecoxib sodium can reduce the dosage of postoperative analgesia medications with an accurate analgesic effect; therefore, it deserves to be widely recommended in the clinic.

  13. THE PHARMACOLOGY RESEARCH OF THENORPHINE,A NEW DRUG OF ANALGESIA AND DETOXIFICATION

    Institute of Scientific and Technical Information of China (English)

    GongZe-Hui; YueYong-Juan; CuiMeng-Xun; QinBo-Yi

    2004-01-01

    Thenorphine is a new parrtail agonist of opioid recepter synthesized by our institute of pharmacology and toxicology.There are double effects of agonist and antegonist on opioid recepter. The agonist effect was showed by analgesia. The analgesic properties are stronger efficacy (ED50 1 mg/kg po) ; longer duration (t1/2 9h) and lower dependence (no physiological

  14. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  15. Condições de atmosfera controlada para pêssegos "maciel" colhidos em dois estádios de maturação Controlled atmosphere storage for 'maciel' peaches harvested in two ripening stages

    Directory of Open Access Journals (Sweden)

    Ivan Sestari

    2008-08-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito de duas temperaturas e condições de atmosfera controlada (AC sobre a conservação de pêssegos da cultivar Maciel, colhidos em dois estádios de maturação. Os tratamentos avaliados foram: armazenamento refrigerado (AR na temperatura de +0,5°C; AR na temperatura de -0,5°C; 2,0kPa O2 + 4,0kPa CO2 em -0,5°C; 1,0kPa O2 + 3,0kPa CO2 em -0,5°C; 2,0kPa O2 + 6,0kPa CO2 em -0,5°C. As avaliações foram realizadas após 60 dias de armazenamento e mais dois e quatro dias de exposição dos frutos à temperatura de 20ºC. Na análise realizada após dois meses de armazenamento, mais dois dias a 20°C, verificou-se que os frutos submetidos a 2,0kPa de O2 + 4,0 kPa de CO2 apresentaram maior firmeza de polpa em relação aos demais tratamentos, sendo que a mesma não foi influenciada pelo estádio de maturação. Os sólidos solúveis totais foram maiores em frutos com estádio de maturação maduro independente da condição de armazenamento. A ocorrência de podridões e escurecimento interno da polpa não foi influenciada pelo estádio de maturação. No entanto, a condição de AC de 1,0 kPa de O2 + 3,0kPa de CO2 proporcionou o menor percentual de podridões e escurecimento interno da polpa em relação aos demais tratamentos. Na avaliação realizada aos quatro dias de exposição a 20°C, os frutos colhidos no estádio maduro estavam completamente podres, independente da condição de armazenamento praticada.The objective of this research was to evaluate the effect of temperature and controlled atmosphere (CA storage conditions on the quality of 'Maciel' peaches harvested in two ripening stages. The treatments were: refrigerated air storage (RA at +0.5°C; RA at -0.5°C; 2.0kPa O2 + 4.0kPa CO2 plus -0.5°C; 1.0kPa O2 + 3.0kPa CO2 plus -0.5°C; 2.0kPa O2 + 6.0kPa CO2 plus -0.5°C. Evaluations of fruit quality were carried out after two months of storage plus two and four days at 20°C. Fruits stored

  16. A COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE WITH CLONIDINE AND EPIDURAL BUPIVACAINE FOR POST OPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Durga Prasad

    2015-10-01

    Full Text Available BACKGROUND: Clonidine, an α 2 - adrenoreceptor agonist, administered epidurally, is gaining popularity for its analgesic, sympatholytic, hemodynamic stabilizing and sedative properties without significant side effects. METHODS: This present study “ A Comparative Study o f Epidural Bupivac aine w ith Clonidine a nd Epidural Bupivacaine f or Post - o perative Analgesia ” was conducted in 70 cases of ASA grade I and II, between the age groups of 30 - 75yrs undergoing abdominal, gynecological and orthopedic surgeries under epidural anaesthesia. At the e nd of surgery, patients were shifted to recovery room. When patients complained of pain with VAS > 4/10, they were allocated to receive either of B: Plain Bupivacaine 0.125% 10ml (n = 35. B+C: Clonidine 150 mcg (1ml + 0.125% Bupivacaine 9ml (n = 35. The following parameters were monitored: A. Onset of analgesia . B. Duration of analgesia . C. VAS and Quality of analgesia . D. ardio - respiratory effects: Pulse rate, blood pressure, respiratory rate. E. Side effects like: nausea, vomiting, pruritus, hypotensio n, sedation and respiratory depression were studied. ONSET OF ANALGESIA: The time of onset of analgesia in group (B+C was significantly less (12.7 ± 0.87 (S.D min when compared to g roup (B (16 ± 3.34 (S.D min. DURATION OF ANALGESIA: The duration of a nalgesia in group (B+C (225.2 ± 45.74 (SD min was significantly more when compared to group (B (119 ± 29.29 (SD min. VISUAL ANALOGUE SCORE: In comparison of group B and group B+C, highly significant difference in VAS was seen from 15min till 3.5hrs in between the groups. The quality of analgesia in Group B+C was VAS 3 - 4 (good to excellent pain relief, as compared to Group B, where VAS was 2 - 3 (fair to good pain relief. SEDATION: In Group B+C from 30min till 2hrs, 100% of patients were asleep (sedat ion score 3. Even in patients with sedation score 3, patients were calm, quiet and asleep but when questions were asked, they answered with

  17. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study.

    Science.gov (United States)

    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  18. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study

    Science.gov (United States)

    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  19. A COMPARATIVE STUDY BETWEEN INTRATHECAL MORPHINE AND INTRATHECAL BUPRENORPHINE FOR POST - OPERATIVE ANALGESIA FOLLOWING CAESARIAN SECTION UNDER SUB ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Anish M

    2015-05-01

    Full Text Available BACKGROUND: Good pain relief following caesarian section is of great importance and intrathecal opioids provide good quality postoperative analgesia for longer duration. So the following study describes a comparative study between intrathecal morphine and intrathecal buprenorphine for postoperative pain relief following caesarian section (CS under subarachnoid blockade. AIMS: The study was conducted to compare intrathecal morphine and buprenorphine for post of analgesia following CS, to achieve analgesia without seda tion for better maternal child bondage and to popularize intrathecal opioids . MATERIALS AND METHODS: 60 patients posted for CS under SAB were randomly allocated into group A and group B of 30 each, the group A received morphine 0.1 mg and buprenorphine 0 . 0 3 mg was given for group B patients along with the local anaesthetic. Subjective assessment of post - operative analgesia was done by direct questioning of the patient and by a five point pain scores. Duration of analgesia was taken as the time interval betw een the time of injection of intrathecal opiate and the time at which the patient felt pain and requested for additional analgesics. Data’s were analyzed using SPSS 16th version. OBSERVATION AND RESU LTS: The mean duration of post - operative analgesia with i ntrathecal morphine was 24.19+4 . 8 hours and that with buprenorphine was only 11.7+3.28 hours. Over weight patients reported a lower mean duration of analgesia. None of the patients in the study showed any bradycardia, hypotension, desaturation or respirato ry depression. Intrathecal opiates decreased the parenteral opiate requirements. The main side effects noticed were nausea in about 43% of patients in morphine group and 33% of patients in buprenorphine group. CONCLUSIONS: Intrathecal morphine 0 . 1 mg gives good post - operative analgesia of longer duration than buprenorphine 0 . 03mg. The quality of analgesia provided by intrathecal morphine was superior to

  20. EVALUACIÓN DE LA TOLERANCIA A LA SALINIDAD BAJO CONDICIONES CONTROLADAS DE NUEVE CULTIVARES CUBANOS DE SOYA (Glycine max (L. Merril

    Directory of Open Access Journals (Sweden)

    Yuniet Hernández Avera

    2015-01-01

    Full Text Available La salinidad es una amenaza creciente para la productividad de cultivares de soya ( Glycine max (L. Merril. Diferentes estrategias se han adoptado para superar el problema de la baja productividad. El empleo de genotipos tolerantes a la salinidad es una buena opción para obtener rendimientos económicos en estas áreas. Por esta razón, es importante disponer de métodos rápidos para evaluar la tolerancia a este estrés sobre todo en las primeras etapas de su crecimiento. El objetivo del presente estudio fue evaluar la tolerancia a la salinidad en nueve genotipos de soya. Los experimentos se desarrollaron en casas verdes bajo condiciones controladas. El índice de tolerancia a la salinidad de germinación (IG, longitud de los brotes (ILB, longitud de la raíz (ILR, materia seca de brotes (IMSB y de la raíz (IMSR, así como la lesión de la membrana celular se midieron en todos los genotipos tratados con NaCl en concentraciones de 0 y 150 mM. Los resultados, a partir de los criterios fisiológicos, permitieron identificar a los cultivares AT22 e INCASoy36 como los más tolerantes en comparación con el resto de los genotipos, por lo que pueden considerarse como prometedores para elevar la productividad en las zonas afectadas por la sal.

  1. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  2. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  3. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

    Directory of Open Access Journals (Sweden)

    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  4. Opioides en el tratamiento del dolor oncológico calidad de vida, grado de analgesia y efectos indeseables /

    OpenAIRE

    De Sanctis Briggs, Vicente

    2011-01-01

    Descripció del recurs: 22 juliol 2011 Introducción: El dolor es el síntoma más frecuente en los pacientes con cáncer: 50-85% presentan dolor significativo y 42% no reciben analgesia adecuada. La evaluación de la analgesia en el paciente oncológico debe basarse en el binomio analgesia- calidad de vida y no sólo en la cuantificación del dolor, porque ello proporciona una visión unidimensional, que omite información sobre el impacto psicológico, social y del entorno del paciente. El objetivo ...

  5. Selective antagonism of opioid-induced ventilatory depression by an ampakine molecule in humans without loss of opioid analgesia.

    Science.gov (United States)

    Oertel, B G; Felden, L; Tran, P V; Bradshaw, M H; Angst, M S; Schmidt, H; Johnson, S; Greer, J J; Geisslinger, G; Varney, M A; Lötsch, J

    2010-02-01

    Ventilatory depression is a significant risk associated with the use of opioids. We assessed whether opioid-induced ventilatory depression can be selectively antagonized by an ampakine without reduction of analgesia. In 16 healthy men, after a single oral dose of 1,500 mg of the ampakine CX717, a target concentration of 100 ng/ml alfentanil decreased the respiratory frequency by only 2.9 +/- 33.4% as compared with 25.6 +/- 27.9% during placebo coadministration (P CX717 than with placebo. In contrast, CX717 did not affect alfentanil-induced analgesia in either electrical or heat-based experimental models of pain. Both ventilatory depression and analgesia were reversed with 1.6 mg of naloxone. These results support the use of ampakines as selective antidotes in humans to counter opioid-induced ventilatory depression without affecting opioid-mediated analgesia. PMID:19907420

  6. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol

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    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  7. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Background and Aims: Opioids as epidural adjunct to local anesthetics (LA have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (ASA physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD and Ropivacaine + Fentanyl (RF, comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94 and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78 was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42 and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96 during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on

  8. Selective antagonism of opioid-induced ventilatory depression by an ampakine molecule in humans without loss of opioid analgesia

    OpenAIRE

    Felden, Lisa

    2010-01-01

    Despite sensible guidelines for the use of opioid analgesics, respiratory depression remains a significant risk with a possibility of fatal outcomes. Clinicians need to find a balance of analgesia with manageable respiratory effects. The ampakine CX717 (Cortex Pharmaceuticals, Irvine, CA, USA), an allosteric enhancer of glutamate-stimulated AMPA receptor activation, has been shown to counteract opioid-induced respiratory depression in rats while preserving opioid-induced analgesia. Adopting a...

  9. COMPARISION OF TWO DRUG COMBINATIONS FOR LABOUR ANALGESIA, AND ITS EFFECT ON PATIENT SATISFACTION, DURATION OF LABOUR AND FETAL OUTCOME

    OpenAIRE

    Jaideep; Pallavi

    2014-01-01

    : BACKGROUND: Epidural is now established and accepted method to relief labour pain. This study intended to comparison of two drug combinations in labour analgesia and its effect on duration of labour, maternal satisfaction and fetal outcome. Combined epidural infusion of bupivacaine + fentanyl would result in analgesia superior to that provided by a continuous epidural infusion of a similar concentration of Bupivacaine alone. AIMS AND OBJECTIVE: To compare the efficacy of...

  10. 5-Methoxy-N,N-dimethyltryptamine-induced analgesia is blocked by alpha-adrenoceptor antagonists in rats.

    OpenAIRE

    Archer, T.; Danysz, W; Jonsson, G.; Minor, B. G.; Post, C

    1986-01-01

    The effects of the alpha-adrenoceptor antagonists prazosin, phentolamine and yohimbine upon 5-methoxy-N,N-dimethyltryptamine (5-MeODMT)-induced analgesia were tested in the hot-plate, tail-flick and shock-titration tests of nociception with rats. Intrathecally injected yohimbine and phentolamine blocked or attenuated the analgesia produced by systemic administration of 5-MeODMT in all three nociceptive tests. Intrathecally administered prazosin attenuated the analgesic effects of 5-MeODMT in ...

  11. Electroacupuncture-induced analgesia in a rat model of ankle sprain pain is mediated by spinal alpha-adrenoceptors

    OpenAIRE

    Koo, Sung Tae; Lim, Kyu Sang; Chung, Kyungsoon; Ju, Hyunsu; Chung, Jin Mo

    2007-01-01

    In a previous study, we showed that electroacupuncture (EA) applied to the SI-6 point on the contralateral forelimb produces long-lasting and powerful analgesia in pain caused by ankle sprain in a rat model. To investigate the underlying mechanism of EA analgesia, the present study tested the effects of various antagonists to known endogenous analgesic systems in this model. Ankle sprain was induced in anesthetized rats by overextending their right ankle with repeated forceful plantar flexion...

  12. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Este estudo avaliou a eficácia da injeção única de bupivacaína a 0,25% no compartimento do psoas ou perivascular inguinal por meio do estimulador de nervos periféricos para analgesia pós-operatória em pacientes submetidos a intervenções cirúrgicas ortopédicas. MÉTODO: Cem pacientes receberam bloqueio do plexo lombar através do compartimento do psoas e foram comparados com 100 pacientes que receberam bloqueio do plexo lombar via perivascular inguinal, identificados pelo estimulador de nervos periféricos com a injeção de 40 mL bupivacaína a 0,25% sem epinefrina. A analgesia nos nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foi avaliada 4, 8, 12, 16, 20 e 24 horas após o final da intervenção cirúrgica. A intensidade da dor foi também avaliada no mesmo período. A quantidade de opióides administrada no pós-operatório foi anotada. Em cinco pacientes de cada grupo, estudo radiográfico com contraste não-iônico foi realizado para avaliar a dispersão da solução anestésica. RESULTADOS: Os nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foram bloqueados em 92% dos pacientes no compartimento do psoas versus 62% no bloqueio perivascular inguinal. O bloqueio do plexo lombar reduziu a necessidade de opióides e 42% dos pacientes submetidos ao bloqueio do compartimento do psoas e 36% dos pacientes no bloqueio inguinal não necessitaram de analgésico adicional no pós-operatório. A duração da analgesia foi em torno de 21 horas com bloqueio do compartimento do psoas e 15 horas com bloqueio perivascular inguinal. CONCLUSÕES: O bloqueio do compartimento do psoas e perivascular inguinal é uma excelente técnica para analgesia pós-operatória em intervenções cirúrgicas ortopédicas reduzindo a necessidade de opióides. Este estudo mostrou que a injeção no compartimento do psoas foi mais fácil e mais efetiva no bloqueio

  13. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

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    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  14. Regimes de atmosfera controlada para o armazenamento de caqui ‘Kyoto’ Controlled atmosphere conditions for ‘Kyoto’ persimmon storage

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    Auri Brackmann

    2004-10-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito de regimes de atmosfera controlada associados ou não com o uso de baixa umidade relativa e com a aplicação pós-colheita de fungicida sobre a conservação da qualidade de caqui ‘Kyoto’. Após o período de dois meses de armazenamento refrigerado a -0,5°C mais cinco dias a 20ºC, a firmeza de polpa manteve-se mais elevada nos frutos submetidos a 0,5kPa de O2 e 5kPa de CO2. A maior incidência de podridões ocorreu nos frutos armazenados a 2kPa de O2 + 10kPa de CO2. Baixa umidade relativa (90% ou pressões parciais elevadas de CO2 (10 a 15kPa aumentaram o escurecimento da epiderme.This work aimed to evaluate the effect of different partial pressures of O2 and CO2, combined or not with the use of low relative humidity (RH and the postharvest fungicide application, on the quality of ‘Kyoto’ persimmons during controlled atmosphere (CA storage. After two months of storage at -0.5°C plus five days at 20ºC, the highest flesh firmness was obtained in fruits stored in CA conditions of 0.5kPa of O2 and 5kPa of CO2. The highest rot incidence was observed in fruits stored at 2kPa O2 + 10kPa CO2. Low RH (90% or high CO2 levels (10 to 15kPa led to increased skin blackening.

  15. Manejo do etileno em ameixas 'Laetitia' armazenadas sob atmosferas controlada e modificada ativa 'Laetitia' plums stored in controlled atmosphere and active modified atmosphere packing with ethylene management

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    Thais Roseli Corrêa

    2011-09-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito de condições de atmosfera controlada (AC e atmosfera modificada (AM ativa (filme PEBD de 40 µm, com duas perfurações de 1,0 mm de diâmetro, associadas ao manejo do etileno, sobre a manutenção da qualidade em ameixas 'Laetitia'. Os tratamentos avaliados consistiram no armazenamento refrigerado (60 dias a 0,5±0,1ºC em: atmosfera refrigerada (AR; 21,0 kPa O2 + The objective of this work was to evaluate the effect of controlled atmosphere (CA and active modified atmosphere packing (MAP [LDPE film (40 µm, with two perforations (diameter = 1.0 mm with ethylene management, on quality preservation of 'Laetitia' plums. The cold storage (60 days at 0.5±0.1ºC treatments evaluated were: stored atmosphere (SA; 21.0 kPa O2 + <0.03 kPa CO2; MAP; MAP + low ethylene (LE; CA; and CA + treatment with 1-MCP (1,0 µL L-1. The partial pressures of O2 + CO2 (kPa were 1.0 + 1.0and 2.5 + <0.1, in CA and MAP, respectively. Fruits stored in CA, regardless of ethylene removal, showed ripening delay compared to fruit in CS. However, the best preservation of flesh texture and titratable acidity was achieved in CA + 1-MCP. The incidences of decay, skin cracking and flesh browning were not different between treatments. Fruits stored in MAP + LE and CA + 1-MCP had lower of internal darkening and higher acceptability for color and taste compared to fruit stored in SA.

  16. [Analgesia, sedation and delir – Treatment of patients in the neuro intensive care unit].

    Science.gov (United States)

    Jungk, Christine

    2015-11-01

    Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. Remifentanil, sufentanil and fentanyl have been proven safe and effective for continuous application; however, bolus application should be avoided. (S-)Ketamin can be considered safe when mechanical ventilation and sedation with GABA receptor agonists are applied. Propofol and benzodiazepines are equally safe and effective with shorter wake up times for propofol. The use of barbitarutes is restricted to intractable intracranial hypertension or status epilepicus. Evidence for alpha-2-adrenoceptoragonists and inhalative sedation is poor and requires further research.

  17. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Carstensen, M.; Møller, Ann

    2010-01-01

    In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient......-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. Our primary aim was to compare the effectiveness and safety of postoperative administered ketamine in addition to opioid for i.v. PCA compared with i.v. PCA with opioid alone. Studies were identified from the Cochrane Library 2003...... of 4.5. Pain was assessed using visual analogue scales or verbal rating scales. Six studies showed significant improved postoperative analgesia with the addition of ketamine to opioids. Five studies showed no significant clinical improvement. For thoracic surgery, the addition of ketamine to opioid...

  18. Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

    Science.gov (United States)

    Harless, Megan; Depp, Caleb; Collins, Shawn; Hewer, Ian

    2015-06-01

    Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia. PMID:26137757

  19. [Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology].

    Science.gov (United States)

    Tablov, B; Popov, I; Tablov, V; Radev, R

    2005-01-01

    The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects. PMID:16544723

  20. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  1. COMPARISON OF PREOPERATIVE RECTAL DICLOFENAC AND RECTAL PARACETAMOL FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Ketaki

    2014-01-01

    Full Text Available Acute postoperative pain has adverse effects on the patients moral as well as various physiological functions of the body. We conducted a prospective randomized study to compare the efficacy of preoperative rectal diclofenac and paracetamol for postoperative analgesia in pediatric age group. Sixty children (3 – 13 yrs. undergoing minor surgical procedures were randomly alloc ated into 2 groups, group I comprising of 30 children who received diclofenac suppository post induction and group II comprising of 30 children who received paracetamol suppository post induction. Pain was assessed by the “Hanallah pain scale” which catego rizes pain based on 5 parameters, viz, systolic blood pressure, crying, movements, agitation (confused, excited, and complaints of pain 1 . We concluded that though both, diclofenac sodium and paracetamol are good postoperative analgesics when given by rect al route in pediatric patients undergoing minor surgeries, diclofenac sodium provides better analgesia than paracetamol when given by rectal route in pediatric patients.

  2. Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement.

    Science.gov (United States)

    Patterson, D R; Questad, K A; de Lateur, B J

    1989-01-01

    This paper presents a hypnotherapeutic intervention for controlling pain in severely burned patients while they go through dressing changes and wound debridement. The technique is based on Barber's (1977) Rapid Induction Analgesia (RIA) and involves hypnotizing patients in their rooms and having their nurses provide posthypnotic cues for analgesia during wound cleaning. Five subjects who underwent hypnotherapy showed reductions on their pain rating scores (Visual Analogue Scale) relative to their own baselines and to the pain curves of a historical control group (N = 8) matched for initial pain rating scores. Although the lack of randomized assignment to experimental and control groups limited the validity of the results, the findings provide encouraging preliminary evidence that RIA offers an efficient and effective method for controlling severe pain from burns. PMID:2563925

  3. Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.

    Science.gov (United States)

    Riker, Richard R; Gagnon, David J; May, Teresa; Seder, David B; Fraser, Gilles L

    2015-12-01

    The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy. PMID:26670815

  4. Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

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    A. L. M. J. van der Knijff-van Dortmont

    2016-01-01

    Full Text Available SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

  5. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

    DEFF Research Database (Denmark)

    Fischer, H.B.; Simanski, C.J.; Sharp, C.;

    2008-01-01

    The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are then...... (TKA). The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression...

  6. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

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    Sukhen Samanta

    2016-01-01

    Full Text Available Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001 regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

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

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    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.

  8. Capnography monitoring during procedural sedation and analgesia: a systematic review protocol

    OpenAIRE

    Conway, Aaron; Douglas, Clint; Sutherland, Joanna

    2015-01-01

    Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inade...

  9. Evaluating and monitoring analgesia and sedation in the intensive care unit

    OpenAIRE

    Sessler, Curtis N; Jo Grap, Mary; Ramsay, Michael AE

    2008-01-01

    Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly ...

  10. Correlation of serum oestrogen level with duration of post operative analgesia

    Directory of Open Access Journals (Sweden)

    Pramod Kumar

    2007-01-01

    The results analysed showed that there was a clinically significant but statistically non significant reduction in 24hr VAS score in Group I& III patients than Group II patients who had a high oestrogen level. A negative correlation between serum oestrogen and mean duration of analgesia further support this, indicating that low serum oestrogen level decreases pain sensitiv-ity and high serum oestrogen level increases pain sensitivity.

  11. Effect of local anaesthesia and/or analgesia on pain responses induced by piglet castration

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    Nyman Görel

    2011-05-01

    Full Text Available Abstract Background Surgical castration in male piglets is painful and methods that reduce this pain are requested. This study evaluated the effect of local anaesthesia and analgesia on vocal, physiological and behavioural responses during and after castration. A second purpose was to evaluate if herdsmen can effectively administer anaesthesia. Methods Four male piglets in each of 141 litters in five herds were randomly assigned to one of four treatments: castration without local anaesthesia or analgesia (C, controls, analgesia (M, meloxicam, local anaesthesia (L, lidocaine, or both local anaesthesia and analgesia (LM. Lidocaine (L, LM was injected at least three minutes before castration and meloxicam (M, LM was injected after castration. During castration, vocalisation was measured and resistance movements judged. Behaviour observations were carried out on the castration day and the following day. The day after castration, castration wounds were ranked, ear and skin temperature was measured, and blood samples were collected for analysis of acute phase protein Serum Amyloid A concentration (SAA. Piglets were weighed on the castration day and at three weeks of age. Sickness treatments and mortality were recorded until three weeks of age. Results Piglets castrated with lidocaine produced calls with lower intensity (p p p = 0.06, n.s. and the following day (p = 0.02. Controls had less swollen wounds compared to piglets assigned to treatments M, L and LM (p p = 0.005; p = 0.05 for C + L compared to M + LM. Ear temperature was higher (p Conclusions The study concludes that lidocaine reduced pain during castration and that meloxicam reduced pain after castration. The study also concludes that the herdsmen were able to administer local anaesthesia effectively.

  12. Regional analgesia for video-assisted thoracic surgery – a systematic review

    DEFF Research Database (Denmark)

    Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik;

    2013-01-01

    Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncologic lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy; however...... unique 1542 abstracts, 17 articles were included for qualitative assessment, of which 3 were studies on VATS lobectomy. The analgesic techniques included TEA, multilevel- and single PVB, paravertebral catheter, intercostal catheter, interpleural infusion and long thoracic nerve block. Overall the studies...

  13. Effetto dell'analgesia epidurale sulla progressione della testa fetale valutata mediante ecografia 3D

    OpenAIRE

    Arcangeli, Tiziana

    2014-01-01

    Introduzione: L'analgesia epidurale è stata messa in correlazione con l'aumento della durata del secondo stadio del travaglio e del tasso di utilizzo della ventosa ostetrica. Diversi meccanismi sono stati ipotizzati, tra cui la riduzione di percezione della discesa fetale, della forza di spinta e dei riflessi che promuovono la progressione e rotazione della testa fetale nel canale del parto. Tali parametri sono solitamente valutati mediante esame clinico digitale, costantemente riportato ...

  14. A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol

    Institute of Scientific and Technical Information of China (English)

    JIA Dong-lin; NI Cheng; XU Ting; ZHANG Li-ping; GUO Xiang-yang

    2010-01-01

    Background Early studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration. Methods Eighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mgkg-1·h-1 tramadol with no naloxone (group I, n=20), 0.05 μg-kg-1·h-1 naloxone (group II, n=20), 0.1 μg·kg-1·h-1 naloxone (group III, n=20) and 0.2 μg·kg-1·h-1 naloxone (group IV, n=20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6,12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers. Results Seventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P <0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P <0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P<0.01). Conclusion A small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

  15. [The characteristics of epidural analgesia during the removal of lumbar intervertebral disk hernias].

    Science.gov (United States)

    Arestov, O G; Solenkova, A V; Lubnin, A Iu; Shevelev, I N; Konovalov, N A

    2000-01-01

    Epidural analgesia (EA) was used in 29 patients undergoing surgical removal of lumbar discal hernia. Marcain EA with controlled medicinal sleep and non-assisted breathing allowed to perform the whole operation in 27 patients. EA may be ineffective in combination of sequestrated disk hernia with scarry adhesive process. The technique of the operation demands a single use of the anesthetic drug which is potent enough to make blockade throughout the operation up to the end. PMID:10738758

  16. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol.

    Science.gov (United States)

    Rawal, N; Allvin, R; Amilon, A; Ohlsson, T; Hallén, J

    2001-02-01

    We compared in a prospective, randomized, double-blinded study the analgesic efficacy of three drugs in 120 ASA I and II patients scheduled to undergo ambulatory hand surgery with IV regional anesthesia. At discharge, oral analgesic tablets were prescribed as follows: tramadol 100 mg every 6 h, metamizol 1 g every 6 h, and paracetamol (acetaminophen) 1 g every 6 h. Rescue medication consisted of oral dextropropoxyphene 100 mg on demand. Analgesic efficacy was evaluated by self-assessment of pain intensity by visual analog score at six different time intervals during the 48-h study period. Patients also recorded global pain relief on a 5-grade scale, total number of study and rescue analgesic tablets, frequency and severity of adverse effects, sleep pattern, and overall satisfaction. None of the study drugs alone provided effective analgesia in all patients. The percentage of patients who required supplementary analgesics was 23% with tramadol, 31% with metamizol, and 42% with acetaminophen. Tramadol was the most effective analgesic, as evidenced by low pain scores, least rescue medication, and fewest number of patients with sleep disturbance. However, the incidence of side effects was also increased with tramadol. Seven patients (17.5%) withdrew from the study because of the severity of nausea and dizziness associated with the use of tramadol. Metamizol and acetaminophen provided good analgesia in about 70% and 60% of patients, respectively, with a decreased incidence of side effects. Despite receiving oral analgesic medication, up to 40% of patients undergoing hand surgery experienced inadequate analgesia in this controlled trial. Although tramadol was more effective, its use was associated with the highest frequency and intensity of adverse effects and the most patient dissatisfaction. Metamizol and acetaminophen provided good analgesia with a small incidence of side effects. For patients undergoing ambulatory hand surgery, postoperative pain can last longer than

  17. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  18. Analgesia and Addiction in Emergency Department Patients with Acute Pain Exacerbations

    OpenAIRE

    Gorchynski, Julie; Kelly, Kevin

    2005-01-01

    Introduction: There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?” Objectives: To determine whether the presence o f specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drug addicted patients, to asse...

  19. Bupivacaine in microcapsules prolongs analgesia after subcutaneous infiltration in humans: a dose-finding study

    DEFF Research Database (Denmark)

    Pedersen, Juri L; Lillesø, Jesper; Hammer, Niels A;

    2004-01-01

    In this study, we examined the onset and duration of local analgesic effects of bupivacaine incorporated into biodegradable microcapsules (extended-duration local anesthetic; EDLA) administered as subcutaneous infiltrations in different doses in humans. In 18 volunteers, the skin on the medial calf...... concentrations were evaluated. No serious side effects were observed for up to 6 mo after administration. In conclusion, bupivacaine incorporated in microcapsules provided analgesia for 96 h after subcutaneous infiltration....

  20. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    OpenAIRE

    Lin Y; Li Q; Yang R; Liu J

    2016-01-01

    Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred ...

  1. Maternal and Cord Serum Cytokine Changes with Continuous and Intermittent Labor Epidural Analgesia: A Randomized Study

    OpenAIRE

    Mantha, Venkat R.; Vallejo, Manuel C.; Vimala Ramesh; Jones, Bobby L; Sivam Ramanathan

    2012-01-01

    Background. Maternal fever during labor epidural analgesia (LEA) may cause increased maternal and cord serum inflammatory cytokines. We report the effects of intermittent and continuous LEA on these cytokines. Methods. Ninety-two women were randomly assigned to continuous (CLEA) or intermittent (ILEA) groups, 46 in each. Maternal temperature was checked and blood drawn at epidural insertion (baseline) and four-hourly until 4 h postpartum (4 PP). Cord blood was drawn after placental delivery. ...

  2. Utilização da contagem de folículos antrais para predição do padrão de resposta em ciclos de hiperestimulação controlada com antagonista de GnRH Use of antral follicle count to predict the response pattern in controlled ovarian hyperstimulation cycles with GnRH antagonist

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Borges de Souza

    2008-01-01

    Full Text Available OBJETIVO: verificar se existe relação preditiva entre a contagem de folículos antrais (CFA no segundo dia do ciclo com o padrão de resposta em ciclos de hiperestimulação ovariana controlada para injeção intracitoplasmática de espermatozóide (ICSI. MÉTODOS: estudo prospectivo, desenvolvido de maio de 2004 a maio de 2005, no qual 51 pacientes com idade 15 mm no dia do desencadeamento da ovulação, número total e em metáfase II de oócitos captados, número de embriões de boa qualidade transferidos e taxa de gestação. A análise estatística foi realizada pelos testes t de Student e de Mann-Whitney, com significância estatística de 5% (pPURPOSE: to establish whether there is a predictive relationship between the antral follicle count (AFC on the second day of the cycle and the response pattern in controlled ovarian hyperstimulation cycles for intracytoplasmic sperm injection (ICSI. METHODS: a prospective study developed from May 2004 to May 2005, in which 51 patients aged 15 mm on the day of ovulation triggering, the total number of oocytes retrieved and in metaphases II, the number of good quality embryos transferred and pregnancy rate. The statistical analysis was performed by the t-Student test and the Mann-Whitney test, with statistical significance of 5% (p15 mm on the day of ovulation triggering (p=0.0001, the total number of oocytes retrieved (p=0.0001 and those in metaphases II (p=0.0001. Such correlation between AFC and pregnancy was not observed (p=0.43. There was no significant correlation between AFC and the number of good quality embryos transferred (p=0.081. CONCLUSIONS: AFC on the second day of the stimulated cycle can be used to predict the quality of ovarian stimulation, the number of oocytes retrieved and the number of mature oocytes in in vitro fertilization cycles using GnRH antagonist.

  3. Effect of epidural analgesia with 0.075% ropivacaine versus 0.1%ropivacaine on the maternal temperature during labor:a randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    YUE Hong-li; SHAO Liu-jiazi; LI Jin; WANG Ya-nan; WANG Lei; HAN Ru-quan

    2013-01-01

    Background A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever.Recently,evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever.The aim of the present study was to investigate the effects of epidural analgesia with 0.075% or 0.1%ropivacaine on the maternal temperature during labor.Methods Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine.Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 μg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine,and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlled epidural analgesia.The measurements included the maternal oral temperature,visual analog scale pain scores,labor events and neonatal outcomes.Results Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation of analgesia and the oxytocin administration during labor compared with the one with 0.1%ropivacaine.Moreover,0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes.Conclusion Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor.

  4. Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Alka Shah

    2013-02-01

    Full Text Available Background: For lower abdomen and lower limb surgery, spinal anaesthesia is most common modality used in routine. This study was conducted on 50 ASA 1 and 2 planned for lower limb and lower abdomen surgery. Methods: 50 patients of ASA 1 and 2 scheduled for lower limb and lower abdominal surgery were selected. Each patient received 4 milliliter volume of 0.75% isobaric ropivacaine + 5 microgram dexmedetomidine. At the intervals of 1 minute, 2 minute, 5 minute, 10 minute, 20 minute, 30 minute and 1 hour, 2 hour and 3 hour reading of pulse rate and blood pressure were recorded. Postoperatively, pain scores were recorded by using Visual Analogue Scale. Results: There were no significant changes in systolic and diastolic blood pressure after induction. The combination of ropivacaine and dexmedetomidine provided better postoperative analgesia and reduced requirement of diclofenac injection in first 24 hour. Conclusions: The patients showed excellent hemodynamic stability and postoperative analgesia to ropivacaine + dexmedetomidine. Thus it is a safe modality for lower limb and lower abdomen surgery as far as haemodynamic effects and postoperative analgesia is concerned. [Int J Basic Clin Pharmacol 2013; 2(1.000: 26-29

  5. Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

    BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

  6. Placebo analgesia and its opioidergic regulation suggest that empathy for pain is grounded in self pain.

    Science.gov (United States)

    Rütgen, Markus; Seidel, Eva-Maria; Silani, Giorgia; Riečanský, Igor; Hummer, Allan; Windischberger, Christian; Petrovic, Predrag; Lamm, Claus

    2015-10-13

    Empathy for pain activates brain areas partially overlapping with those underpinning the first-hand experience of pain. It remains unclear, however, whether such shared activations imply that pain empathy engages similar neural functions as first-hand pain experiences. To overcome the limitations of previous neuroimaging research, we pursued a conceptually novel approach: we used the phenomenon of placebo analgesia to experimentally reduce the first-hand experience of pain, and assessed whether this results in a concomitant reduction of empathy for pain. We first carried out a functional MRI experiment (n = 102) that yielded results in the expected direction: participants experiencing placebo analgesia also reported decreased empathy for pain, and this was associated with reduced engagement of anterior insular and midcingulate cortex: that is, areas previously associated with shared activations in pain and empathy for pain. In a second step, we used a psychopharmacological manipulation (n = 50) to determine whether these effects can be blocked via an opioid antagonist. The administration of the opioid antagonist naltrexone blocked placebo analgesia and also resulted in a corresponding "normalization" of empathy for pain. Taken together, these findings suggest that pain empathy may be associated with neural responses and neurotransmitter activity engaged during first-hand pain, and thus might indeed be grounded in our own pain experiences.

  7. A meta-analysis of brain mechanisms of placebo analgesia: consistent findings and unanswered questions.

    Science.gov (United States)

    Atlas, Lauren Y; Wager, Tor D

    2014-01-01

    Placebo treatments reliably reduce pain in the clinic and in the lab. Because pain is a subjective experience, it has been difficult to determine whether placebo analgesia is clinically relevant. Neuroimaging studies of placebo analgesia provide objective evidence of placebo-induced changes in brain processing and allow researchers to isolate the mechanisms underlying placebo-based pain reduction. We conducted formal meta-analyses of 25 neuroimaging studies of placebo analgesia and expectancy-based pain modulation. Results revealed that placebo effects and expectations for reduced pain elicit reliable reductions in activation during noxious stimulation in regions often associated with pain processing, including the dorsal anterior cingulate, thalamus, and insula. In addition, we observed consistent reductions during painful stimulation in the amygdala and striatum, regions implicated widely in studies of affect and valuation. This suggests that placebo effects are strongest on brain regions traditionally associated with not only pain, but also emotion and value more generally. Other brain regions showed reliable increases in activation with expectations for reduced pain. These included the prefrontal cortex (including dorsolateral, ventromedial, and orbitofrontal cortices), the midbrain surrounding the periaqueductal gray, and the rostral anterior cingulate. We discuss implications of these findings as well as how future studies can expand our understanding of the precise functional contributions of the brain systems identified here.

  8. Opposite effects of the same drug: reversal of topical analgesia by nocebo information.

    Science.gov (United States)

    Aslaksen, Per Matti; Zwarg, Maria Lorentze; Eilertsen, Hans-Ingvald Hage; Gorecka, Marta Maria; Bjørkedal, Espen

    2015-01-01

    Several studies have shown that psychological factors such as learning, expectation, and emotions can affect pharmacological treatment and shape both favorable and adverse effects of drugs. This study investigated whether nocebo information provided during administration of an analgesic cream could reverse topical analgesia to hyperalgesia. Furthermore, we tested whether nocebo effects were mediated by negative emotional activation. A total of 142 healthy volunteers (73 women) were randomized into 6 groups. A topical analgesic cream (Emla) was administered together with suggestions of analgesia in 1 group, whereas another group received Emla with suggestions of hyperalgesia. Two other groups received a placebo cream together with the same information as the groups receiving Emla. A fifth group received Emla with no specific information about the effect, and the sixth group received no treatment but the same pain induction as the other groups. Heat pain stimulation (48°C) was administered during a pretest and 2 posttests. Pain was continuously recorded during stimulation, and measures of subjective stress and blood pressure were obtained before the pretest, after the application of cream, and after the posttests. The results revealed that pain was significantly lower in the group receiving Emla with positive information and highest in the groups receiving suggestions of hyperalgesia, regardless of whether Emla or the placebo was administered. Mediation analyses showed that stress and blood pressure mediated hyperalgesia after nocebo suggestions. These results suggest that nocebo information can reverse topical analgesia and that emotional factors can explain a significant proportion of variance in nocebo hyperalgesia.

  9. Neuroimmune Interaction in the Regulation of Peripheral Opioid-Mediated Analgesia in Inflammation.

    Science.gov (United States)

    Hua, Susan

    2016-01-01

    Peripheral immune cell-mediated analgesia in inflammation is an important endogenous mechanism of pain control. Opioid receptors localized on peripheral sensory nerve terminals are activated by endogenous opioid peptides released from immune cells to produce significant analgesia. Following transendothelial migration of opioid-containing leukocytes into peripheral sites of inflammation, opioid peptides are released into a harsh milieu associated with an increase in temperature, low pH, and high proteolytic activity. Together, this microenvironment has been suggested to increase the activity of opioid peptide metabolism. Therefore, the proximity of immune cells and nerve fibers may be essential to produce adequate analgesic effects. Close associations between opioid-containing immune cells and peripheral nerve terminals have been observed. However, it is not yet determined whether these immune cells actually form synaptic-like contacts with peripheral sensory terminals and/or whether they secrete opioids in a paracrine manner. This review will provide novel insight into the peripheral mechanisms of immune-derived analgesia in inflammation, in particular, the importance of direct interactions between immune cells and the peripheral nervous system.

  10. Efficacy of two doses of tramadol versus bupivacaine in perioperative caudal analgesia in adult hemorrhoidectomy

    Science.gov (United States)

    Farag, Hanan M.; Esmat, Ibrahim M.

    2016-01-01

    Background: The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy. Patients and Methods: A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T1; n = 30), tramadol 2 mg/kg in 20 ml (Group T2; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated. Results: Duration of analgesia was longer in Group T2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects. Conclusion: Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy. PMID:27051362

  11. Caudal epidural analgesia using lidocaine alone or in combination with ketamine in dromedary camels (Camelus dromedarius

    Directory of Open Access Journals (Sweden)

    Omid Azari

    2014-02-01

    Full Text Available This study was performed to investigate the analgesic effect of lidocaine and a combination of lidocaine and ketamine following epidural administration in dromedary camels. Ten 12–18-month-old camels were randomly divided into two equal groups. In group L, the animals received 2% lidocaine (0.22 mg/kg and in group LK the animals received a mixture of 10% ketamine (1 mg/kg and 2% lidocaine (0.22 mg/kg administered into the first intercoccygeal (Co1–Co2 epidural space while standing. Onset time and duration of caudal analgesia, sedation level and ataxia were recorded after drug administration. Data were analysed by U Mann-Whitney tests and significance was taken as p < 0.05. The results showed that epidural lidocaine and co-administration of lidocaine and ketamine produced complete analgesia in the tail, anus and perineum. Epidural administration of the lidocaine-ketamine mixture resulted in mild to moderate sedation, whilst the animals that received epidural lidocaine alone were alert and nervous during the study. Ataxia was observed in all test subjects and was slightly more severe in camels that received the lidocaine-ketamine mixture. It was concluded that epidural administration of lidocaine plus ketamine resulted in longer caudal analgesia in standing conscious dromedary camels compared with the effect of administering lidocaine alone.

  12. Neuroimmune Interaction in the Regulation of Peripheral Opioid-Mediated Analgesia in Inflammation.

    Science.gov (United States)

    Hua, Susan

    2016-01-01

    Peripheral immune cell-mediated analgesia in inflammation is an important endogenous mechanism of pain control. Opioid receptors localized on peripheral sensory nerve terminals are activated by endogenous opioid peptides released from immune cells to produce significant analgesia. Following transendothelial migration of opioid-containing leukocytes into peripheral sites of inflammation, opioid peptides are released into a harsh milieu associated with an increase in temperature, low pH, and high proteolytic activity. Together, this microenvironment has been suggested to increase the activity of opioid peptide metabolism. Therefore, the proximity of immune cells and nerve fibers may be essential to produce adequate analgesic effects. Close associations between opioid-containing immune cells and peripheral nerve terminals have been observed. However, it is not yet determined whether these immune cells actually form synaptic-like contacts with peripheral sensory terminals and/or whether they secrete opioids in a paracrine manner. This review will provide novel insight into the peripheral mechanisms of immune-derived analgesia in inflammation, in particular, the importance of direct interactions between immune cells and the peripheral nervous system. PMID:27532001

  13. Analgesia epidural torácica para el tratamiento de la angina inestable Thoracal epidural analgesia for the management of unstable angina

    Directory of Open Access Journals (Sweden)

    M. Castro

    2005-07-01

    Full Text Available La miocardiopatía isquémica en pacientes con angina inestable refractaria al tratamiento médico constituye un escenario clínico complicado. Una anatomía desfavorable o un riesgo quirúrgico excesivamente alto pueden desaconsejar la realización de una angioplastia o de una cirugía de derivación coronaria. En este artículo se pretende revisar la utilización de la analgesia/anestesia epidural torácica para el tratamiento y estabilización de este tipo de pacientes, a través de una breve descripción de la fisiopatología de la isquemia cardiaca, estudios experimentales en animales y humanos, uso en cirugía cardiaca y efectos secundarios.Ischemic cardiomyopathy in patients with unstable angina refractory to medical therapy is a difficult medical condition. Unfavorable anatomy or excessive surgical risk can advise against the performance of angioplasty or coronary bypass surgery. This study has reviewed the use of thoracal epidural analgesia/anesthesia for the management and stabilization of this type of patients, with a brief description of the physiopathology of cardiac ischemia, experimental studies in animals and human beings, use of cardiac surgery and side effects.

  14. Cold stress effects on cardiomyocytes nuclear size in: light microscopic evaluation Efeitos do estresse pelo frio sobre o tamanho nuclear do cardiomiócito em ratos: avaliação por microscopia de luz

    Directory of Open Access Journals (Sweden)

    Adriano Meneghini

    2008-12-01

    controlada de -8ºC, durante 4 horas uma única vez. Foi realizada análise histológica de fígados e glândulas adrenais para examinar a condição de estresse. O tamanho do núcleo dos cardiomiócitos foi examinado por três investigadores independentes com o mesmo critério padronizado e posteriormente analisado pelo coeficiente de correlação de Bartko (R>0,75=concordância positiva. Teste t de Student foi aplicado. O nível de significância foi considerado como P<0,05. RESULTADOS: O grupo exposto ao estresse pelo frio apresentou maior depleção de lipídio nas glândulas adrenais (P<0,05 e de glicogênio no fígado (P<0,05. O grupo induzido à hipotermia mostrou menor volume do núcleo de seus cardiomiócitos (108 + 1,7 µm³; P<0,05, reduziu em 76% comparado ao grupo controle (142 + 2,3 µm³. Correlação de Bartko: CON=0,44; IH=0,96, a variação entre a média dos grupos foi significativamente diferente. CONCLUSÃO: Esses resultados sugerem que a exposição ao estresse agudo pelo frio induz redução do núcleo dos cardiomiócitos em ratos.

  15. EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR CAUDAL ANALGESIA IN PAEDIATRIC PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Vijay

    2014-07-01

    Full Text Available CONTEXT: Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia with local anesthetics. Dexmedetomidine a α2 agonist is used frequently in adult patients to enhance the local anesthetic effect. However there is little literature regarding its effectiveness in pediatric caudal analgesia. The objective of this study was to assess the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in increasing the duration of caudal analgesia. AIM: The aim of this study was to investigate the effect of adding Dexmedetomidine to caudal Bupivacaine and observe the effect on the duration of analgesia in the post-operative period. SETTINGS AND DESIGN: One year hospital based Double Blind Randomized Controlled Trial. METHODS AND MATERIAL: Sixty children, aged 1-6 years, undergoing lower abdominal surgeries were included in this prospective randomized double-blind study. The patients were randomly divided into two groups: Group I received Bupivacaine (0.25% 1ml/kg plus 1 ml of normal saline in the caudal epidural space. Group II was administered Bupivacaine (0.25% 1ml/ with Dexmedetomidine 2 mcg/ ml diluted to 1 ml of normal saline in the caudal epidural space. All anesthetic and surgical techniques were standardized. Heart rate, blood pressure, oxygen saturation, respiratory rate were monitored continuously. Surgery was started 10-15 minutes after the injection and confirming adequacy of caudal block. Duration of analgesia was assessed using FLACC scale (Face, Legs, Activity, Cry, Consolability scale. The time from administration of caudal anesthesia to the first time the FLACC score equal or greater than 4 was considered as the duration of caudal analgesia. Paracetamol suppository was used as rescue analgesia with a loading dose of 40mg/kg. STATISTICAL ANALYSIS: Mann-Whitney test and Student ‘t’test was used to compare the data obtained in the two groups. RESULTS: The

  16. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

    OpenAIRE

    Liu, E H C; Sia, A T H

    2004-01-01

    Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women.

  17. Investigation of Stress Induced Analgesia with or Without Cck Receptor Agonists and Antagonists in Mice Suffering from Neuropathic Pain Using Hot Plate Test

    Directory of Open Access Journals (Sweden)

    F Samiee

    2004-07-01

    Full Text Available Introduction: Recent studies have shown that cold water swimming stress (CWSS produces analgesia. Although exact mechanism of the analgesia is until unclear, it may attributed to CCK receptors. On the other hand, the effectiveness of analgesic drugs for treatment of neuropathic pain is limited. In the present study, the effects of CCK receptor agonist caerulein and antagonist proglumide , both alone and together on the CWSS- induced analgesia was investigated and compared in normal mice and those whose sciatic nerve was ligated. Material & Methods: In this research, fifty groups of nine male albino mice were used. As a model of neuropathy, the unilateral nerve ligation was made by a surgical procedure on the right hind limb. Pain sensitivity was measured by the hot plate test. Results: Different CWSS regimes (0.5-3 min induced time-dependent analgesia. Nerve ligation did not alter the CWSS induced analgesia. Caerulein (0.025, 0.05 and 0.1 mg/kg induced analgesia in both nerve ligated and intact animals. Different doses of proglumide (20, 40 and 60 mg/kg alone produced analgesic effect. The response of caerulein was not inhibited by proglumide. In the stressed mice, both drugs and the combination of them showed analgesia but there appeared to be no potentiation in CWSS- induced analgesia. Our results indicate no significant relationship between CCK receptors and the CWSS- induced analgesia. Conclusion: Nevertheless, CWSS as an alternative to drug treatment in neuropathic pain requires more studies.

  18. Produção de mudas de espécies arbóreas nativas com combinações de adubos de liberação controlada e prontamente solúveis

    OpenAIRE

    Moraes Neto Sebastião Pires de; Gonçalves José Leonardo de Moraes; Rodrigues Carlos José; Geres Washington Luiz de Azevedo; Ducatti Fabiane; Aguirre Jr. José Hamilton

    2003-01-01

    O objetivo deste estudo foi testar diversas doses e fontes de adubo para verificar o crescimento de mudas de cinco espécies arbóreas nativas. As espécies utilizadas foram as pioneiras Guazuma ulmifolia (mutambo) e Croton floribundus (capixingui), as secundárias iniciais Peltophorum dubium (canafístula) e Gallesia integrifolia (pau-d'alho) e a clímax Myroxylon peruiferum (cabreúva). Os tratamentos consistiram principalmente na utilização de adubo de liberação controlada (ALC, 19-06-10, N-P2O5-...

  19. Conservação de três genótipos de feijão (Phaseolus vulgaris L.) do grupo carioca em armazenamento refrigerado e em atmosfera controlada

    OpenAIRE

    Brackmann Auri; Neuwald Daniel Alexandre; Ribeiro Nerinéia Dalfollo; Freitas Sérgio Tonetto de

    2002-01-01

    O objetivo deste trabalho foi de avaliar o efeito do armazenamento refrigerado (AR) e de atmosfera controlada (AC), sobre a cor do tegumento, germinação, umidade do grão, ocorrência de pragas e facilidade de cozimento de três genótipos de feijão do grupo carioca (?Carioca?, ?Pérola? e a linhagem M91-012). O delineamento experimental utilizado foi inteiramente casualizado, com três repetições, com os seguintes tratamentos: ar em temperatura ambiente (convencional); armazenamento refrigerado a ...

  20. ¿Disminuyen las complicaciones respiratorias postoperatorias en pacientes con enfermedad pulmonar obstructiva crónica con el uso de ventilación controlada por presión en anestesia?

    OpenAIRE

    Barriga Moreno, Adriana Paola

    2013-01-01

    Antecedentes: La ventilación mecánica en una de las principales medidas terapéuticas en anestesiología por lo que se requiere mejorar su conocimiento buscando nuevos modos ventilatorios que permitan tener mejores desenlaces en los pacientes que requieren soporte ventilatorio invasivo durante cirugías realizadas bajo anestesia general. El uso de la ventilación controlada por presión trae ventajas fisiológicas para los pacientes que requieren soporte con ventilación mecánica invasiva, el ob...

  1. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

    Directory of Open Access Journals (Sweden)

    J. A. Delgado

    2005-05-01

    Full Text Available Objetivo: Comparar la eficacia y duración del bloqueo del nervio infraorbitario intraoral bilateral frente a la analgesia intravenosa convencional con tramadol en el control del dolor postoperatorio en lactantes sometidos a queiloplastia por labio leporino. Material y métodos: Tras la realización de una adecuada valoración preanestésica y la obtención del consentimiento informado de los padres, realizamos un estudio prospectivo, controlado aleatorizado y doble ciego en 25 niños, ASA I, con edades comprendidas entre los 3-10 meses, tras obtener el consentimiento informado de los padres, propuestos para cirugía correctora de labio leporino (queiloplastia. Todos ellos fueron premeditados, media hora antes de la intervención quirúrgica, con midazolan oral (0,5 mg.kg-1 y, en todos los casos, se practicó la técnica anestésica y el bloqueo nervioso por el mismo anestesiólogo, que consistió en una inducción inhalatoria con sevoflurano previa a la venoclisis. La anestesia general se completó con atropina, fentanilo y rocuronio a las dosis establecidas que se administraron, por vía intravenosa, previamente a la intubación endotraqueal y la ventilación mecánica. Los pacientes fueron divididos aleatoriamente en dos grupos: Grupo A (n = 12: se administró 1-2 ml de bupivacaína al 0,25% con adrenalina para el bloqueo infraorbitario bilateral y solución salina intravenosa como sustitutivo de la analgesia intravenosa con tramadol. Grupo B (n = 13: se administró solución salina para el bloqueo nervioso, en lugar de la bupivacaína, y tramadol intravenoso (1,5 mg.kg-1 como analgesia postoperatoria. En todos ellos se realizó anestesia general con sevoflurano y fentanilo "a demanda" según parámetros convencionales (tensión arterial, frecuencia cardiaca, tamaño pupilar, etc.. Durante sus primeras seis horas de estancia en Reanimación se valoró la duración de la analgesia, grado de disconfort e intensidad dolorosa. Además se anot

  2. Eficácia da própolis no controlo da loque americana : avaliação em zonas controladas

    OpenAIRE

    Vilas-Boas, Miguel

    2010-01-01

    No âmbito das actividades do Programa Apícola Nacional 2008-2010 medida 6A, a FNAP propôs o desenvolvimento de um trabalho de investigação coordenado pelo Centro de Investigação de montanha e com a colaboração da Universidade do Minho e a Direcção Geral de Veterinária. Este trabalho, apresentado publicamente no último Forum Apícola Nacional que decorreu em Sesimbra em Novembro de 2008, tem por objectivo explorar as potencialidade da própolis no controla da Loque Americana....

  3. Analgesia postoperatoria tras artroplastia de rodilla mediante bloqueo femoral continuo con ropivacaína Postoperative analgesia after knee arthroplasty through continuous femoral blockage with ropivacaine

    Directory of Open Access Journals (Sweden)

    M. Reina

    2004-02-01

    Full Text Available Introducción: El objetivo del estudio es conocer el grado de dolor y satisfacción en el postoperatorio de los pacientes que han recibido analgesia mediante bloqueo femoral continuo en artroplastia total de rodilla. Material y método: Se incluyeron pacientes ASA I-III diagnosticados de gonartrosis e intervenidos de artroplastia total de rodilla bajo anestesia intradural. En la Sala de Despertar y bajo los efectos residuales de la anestesia intradural se colocó un catéter en la proximidad del nervio femoral, con neuroestimulación. Se administró un bolo inicial de ropivacaína 0,375% 30 ml, seguido de una perfusión continua de ropivacaína 0,125% 10 ml.h-1, que se mantuvo durante las primeras 48 horas del postoperatorio. Las variables registradas fueron las siguientes: dolor postoperatorio a las 24 y 48 horas mediante EVA, localización del dolor, existencia o no de bloqueo motor, parestesias-disestesias y efectos secundarios, así como fármacos utilizados en caso de analgesia insuficiente, dificultad de la técnica y grado de satisfacción a las 48 horas. Resultados: Se incluyeron 8 pacientes, con peso y altura media de 78 kg y 157 cm respectivamente. El análisis del dolor registrado a las 24 horas fue en un 62,5% de EVA 0, en un 25% EVA 5 y en un 12,5% EVA 6. A las 48 horas el 87,5% de los pacientes tenían un EVA 0 y un 12,5% EVA 4. Todos los pacientes con dolor lo localizaron en hueco poplíteo. En ningún caso hubo bloqueo motor. El 25% presentaron parestesias a las 24-48 horas y el 12,5% episodio de náuseas. En caso de analgesia insuficiente se complementó el tratamiento con AINE intravenosos y en un caso con bloqueo del nervio ciático por abordaje anterior. La técnica realizada resultó fácil en el 87,5% de los pacientes y muy difícil en el 12,5%. El grado de satisfacción fue superior a 7 en todos los pacientes. Conclusiones: El bloqueo 3 en 1 continuo en nuestra serie, proporcionó una analgesia eficaz en pacientes

  4. Estudio observacional de la analgesia epidural para trabajo de parto: Complicaciones de la técnica en 5.895 embarazadas Observational study of epidural analgesia used in labour: Complications of this technique in 5,895 pregnant women

    Directory of Open Access Journals (Sweden)

    M. Calvo

    2005-04-01

    Full Text Available Objetivos: a Conocer la incidencia de las complicaciones relacionadas con la técnica de analgesia regional durante la realización de la técnica, durante la dilatación y en el postparto; y b conocer si las complicaciones del postparto relacionadas con la técnica analgésica son más frecuentes cuando se realiza la técnica combinada epidural-subaracnoidea (CES en comparación con la analgesia epidural. Material y método: Hemos realizado un estudio observacional descriptivo y analítico. Como sujetos del estudio hemos incluido a todas las mujeres que solicitaron la administración de analgesia regional a la Unidad de Analgesia Epidural de nuestro hospital (5.895 embarazadas y cumplían los criterios de inclusión, en un periodo de tiempo que empieza en el 1 de enero del año 2002 y termina el 1 de enero del año 2003. Las técnicas empleadas para el control del dolor del trabajo del parto fueron la analgesia epidural y la técnica combinada epidural-subaracnoidea. Resultados: La complicación que más frecuentemente apareció durante la realización de la técnica fueron las parestesias (43,5% seguido de la punción hemática (5,9%. La punción no intencionada de la duramadre ha ocurrido en el 0,6%. Las complicaciones que más frecuentemente aparecieron durante el periodo de dilatación fue el prurito (11,4% y la analgesia lateralizada (9%. La complicación más frecuente del periodo postparto fue el dolor de espalda (9,8% y la cefalea (2%. Las complicaciones en general han sido significativamente más frecuentes en las embarazadas a las que se les aplicó la técnica CES, en comparación con la analgesia epidural convencional. Conclusiones: Las complicaciones que pueden aparecer debido a este modo de analgesia van desde unas poco frecuentes y potencialmente peligrosas si pasan desapercibidas (como la inyección intravascular de anestésicos locales o el bloqueo espinal total a otras más frecuentes como las parestesias, con una repercusi

  5. Manejo do etileno durante o armazenamento de ameixas 'Laetitia' em atmosfera controlada Ethylene management during controlled atmosphere storage of 'Laetitia' plums

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    Erlani de Oliveira Alves

    2009-12-01

    Full Text Available Objetivou-se avaliar o efeito da aplicação de 1-metilciclopropeno (1-MCP e de diferentes concentrações de etileno sobre a qualidade de ameixas 'Laetitia' armazenadas em atmosfera controlada (AC. Os tratamentos utilizados foram aplicação de 1-MCP (1,0µL L-1 e etileno (C2H4 nas concentrações de The objective of this research was to evaluate the effects of treatment with 1-methylcyclopropene (1-MCP and different ethylene concentrations in the storage room on f 'Laetitia' plums quality stored under controlled atmosphere. The treatments evaluated were 1-MCP application (1.0µL L-1 and ethylene (C2H4 in the concentrations <0.04µL L-1, 1.0µL L-1, and 10µL L-1 inside the CA storage (1.0kPa of O2+3.0kPa of CO2 / 0.5°C±0.1°C and 95±2% RH of. Respiratory rates were lower in fruits treated with 1-MCP and stored at 10µL L-1 of C2H4. Fruits treated with 1-MCP showed the lowest ethylene production rates. At removal from CA storage, fruits treated with 1-MCP and stored at C2H4 concentration <0.04µL L-1 showed higher flesh firmness and fruit compression resistance and lower flesh browning incidence. After shelf life, fruits treated with 1-MCP had the highest flesh firmness. Titratable acidity was higher in fruit treated with 1-MCP and left in CA storage with <0.04µL L-1 C2H4 concentration. 1-MCP and ethylene absorption delay ripening and reduce flesh browning incidence in 'Laetitia' plums. The effects of 1-MCP persist during shelf life. However, even with the use of these technologies, flesh browning occurrence does not allow fruit storage for 60 days under de CA storage condition used.

  6. Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Li-zhong; CHANG Xiang-yang; LIU Xia; HU Xiao-xia; TANG Bei-lei

    2010-01-01

    Background Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine (Group B), ropivacaine (Group R) or levobupivacaine (Group L) with sufentanil 0.5 μg/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was ≤30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction (P >0.05). The relative median potency was bupivacaine/ropivacaine: 0.828 (0.602-1.091), bupivacaine/levobupivacaine: 0.845 (0.617-1.12), ropivacaine/levobupivacaine: 1.021 (0.774-1.354), respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of ≥0.1% within each group (P<0.05). Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine

  7. Electroacupuncture-induced analgesia in a rat model of ankle sprain pain is mediated by spinal alpha-adrenoceptors.

    Science.gov (United States)

    Koo, Sung Tae; Lim, Kyu Sang; Chung, Kyungsoon; Ju, Hyunsu; Chung, Jin Mo

    2008-03-01

    In a previous study, we showed that electroacupuncture (EA) applied to the SI-6 point on the contralateral forelimb produces long-lasting and powerful analgesia in pain caused by ankle sprain in a rat model. To investigate the underlying mechanism of EA analgesia, the present study tested the effects of various antagonists on known endogenous analgesic systems in this model. Ankle sprain was induced in anesthetized rats by overextending their right ankle with repeated forceful plantar flexion and inversion of the foot. When rats developed pain behaviors (a reduction in weight-bearing of the affected hind limb), EA was applied to the SI-6 point on the contralateral forelimb for 30 min under halothane anesthesia. EA significantly improved the weight-bearing capacity of the affected hind limb for 2h, suggesting an analgesic effect. The alpha-adrenoceptor antagonist phentolamine (2mg/kg, i.p. or 30 microg, i.t.) completely blocked the EA-induced analgesia, whereas naloxone (1mg/kg, i.p.) failed to block the effect. These results suggest that EA-induced analgesia is mediated by alpha-adrenoceptor mechanisms. Further experiments showed that intrathecal administration of yohimbine, an alpha(2)-adrenergic antagonist, reduced the EA-induced analgesia in a dose-dependent manner, whereas terazosin, an alpha(1)-adrenergic antagonist, did not produce any effect. These data suggest that the analgesic effect of EA in ankle sprain pain is, at least in part, mediated by spinal alpha(2)-adrenoceptor mechanisms. PMID:17537577

  8. Analgesia epidural para el trabajo de parto en gestante con esclerosis múltiple Epidural analgesia during labour of a patient with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    M.J. Mayorga Buiza

    2010-07-01

    Full Text Available La Esclerosis Múltiple (EM, es una enfermedad del SNC siendo 2 veces más frecuente su aparición en mujeres, el 70% de ellas en edad fértil. Desde el punto de vista anestésico nos encontramos ante una enfermedad con elevada susceptibilidad neurológica que podría agravarse tanto por la propia cirugía, la técnica anestésica como por la medicación utilizada. Por otra parte se plantea como atender la demanda de analgesia para el trabajo de parto en mujeres con EM, que es el grupo de edad con mayor incidencia de la enfermedad. Presentamos el caso de una mujer de 37 años diagnosticada de esclerosis múltiples 3 años antes, forma recidivante, remitente. La paciente es ingresada en dilatación con 37 semanas de amenorrea, presentando una buena evolución del trabajo de parto y encontrándose el feto en situación longitudinal y presentación cefálica. Avisan al Servicio de Anestesia para valoración de la indicación de epidural para analgesia del parto. La gestante previamente había acudido a consulta de preanestesia donde se le había informado del riesgo beneficio de la técnica y en concreto en su caso, habiendo entendido perfectamente las posibles complicaciones derivadas de la misma y firmado el consentimiento informado. Nosotros hemos preferido utilizar una técnica locoregional, vía epidural considerando también el riesgo potencial de cesárea urgente, para evitar, dado el caso la realización de una técnica intraraquídea o una anestesia general, con las posibilidades de desencadenar un brote que tienen estas técnicas. Además de aportar confort a la paciente durante el trabajo de parto, proporcionar analgesia durante el mismo, disminuye por este motivo el estrés de la gestante pudiendo paralelamente evitar la aparición de un brote.Multiple sclerosis (MS is a disease of the central nervous system (CNS, and twice as prevalent in women, 70% of whom are of fertile age. From an anaesthetics point of view, due to it being a

  9. Increased pain sensitivity but normal function of exercise induced analgesia in hip and knee osteoarthritis - treatment effects of neuromuscular exercise and total joint replacement

    DEFF Research Database (Denmark)

    Kosek, E; Roos, Ewa M.; Ageberg, E;

    2013-01-01

    To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters.......To assess exercise induced analgesia (EIA) and pain sensitivity in hip and knee osteoarthritis (OA) and to study the effects of neuromuscular exercise and surgery on these parameters....

  10. Analgesia continua de miembro superior por bloqueo de plexo braquial en dolor crónico oncológico Continuous analgesia of the upper limb with brachial plexus blockade in chronic cancer pain

    OpenAIRE

    M. Narváez; K. Glasinovic; A. Condori; A. Ballon; M. Torres

    2005-01-01

    Objetivo: Evaluar la utilizdad del bloqueo del plexo braquial en el tratamiento del dolor intenso oncológico. Método: Evaluamos en 6 pacientes con metástasis óseas del miembro superior la efectividad de un bloqueo continuo del plexo braquial. Resultados: Todos los pacientes del estudio tuvieron una evolución favorable y un incremento en la analgesia con el tratamiento sin que se produjeran efectos adversos. Conclusiones: La analgesia continua del plexo braquial es un método efectivo para el c...

  11. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five......-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given.......01). Mean duration of sensory blockade was significantly longer (P less than 0.005) in the patients with chronic pain than in surgical patients (13.1 +/- 1.2 and 8.5 +/- 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine infusion...

  12. Application of forgetful analgesia induction in induction period in patients with obstructive jaundice

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    Wei DU

    2014-03-01

    Full Text Available Objective To observe the effect of forgetful analgesia induction and tracheal intubation on the hemodynamic changes in induction period in patients with obstructive jaundice, and explore a safe method for anesthesia induction and tracheal intubation. Methods Sixty patients with obstructive jaundice undergoing elective abdominal operation in General Hospital of PLA from February, 2013 to August, 2013 were involved in the present study. Participants included 36 male and 24 female patients, aging 19-65 years (mean 42±5 years, weighing 47-73 kg (mean 54±6 kg, with ASA Ⅰ-Ⅱ. These 60 patients were randomly divided into forgetful analgesia induction-tracheal intubation group (group A, n=30 and rapid induction-tracheal intubation group (group B, n=30. The heart rate (HR, mean arterial pressure (MAP, pulse oxygen saturation (SpO2 at the time point of before induction (T0, before intubation (T1, at the moment of intubation (T2 and 3 min after intubation (T3 were determined in both groups. Administration times of ephedrine hydrochloride and atropine was recorded in both groups. Results There was no significant difference in HR, MAP, SpO2 before and after induction in group A. In the patients of group B, the HR increased and MAP decreased after induction compared with those before induction (P<0.05, and the change of SpO2 was not significant. Ephedrine hydrochloride and atropine were administrated in both groups, and the cases and times of ephedrine hydrochloride administration were more in group B than in group A (P<0.05. Conclusion The forgetful analgesia induction-tracheal intubation could effectively control the stress response and reduce the fluctuation in hemodynamics during induction of anesthesia in patients with obstructive jaundice. DOI: 10.11855/j.issn.0577-7402.2014.02.15

  13. Synergistic analgesia of duloxetine and celecoxib in the mouse formalin test: a combination analysis.

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    Yong-Hai Sun

    Full Text Available Duloxetine, a serotonin and noradrenaline reuptake inhibitor, and celecoxib, a non-steroidal anti-inflammatory drug, are commonly used analgesics for persistent pain, however with moderate gastrointestinal side effects or analgesia tolerance. One promising analgesic strategy is to give a combined prescription, allowing the maximal or equal efficacy with fewer side effects. In the current study, the efficacy and side effects of combined administration of duloxetine and celecoxib were tested in the mouse formalin pain model. The subcutaneous (s.c. injection of formalin into the left hindpaw induced significant somatic and emotional pain evaluated by the biphasic spontaneous flinching of the injected hindpaw and interphase ultrasonic vocalizations (USVs during the 1 h after formalin injection, respectively. Pretreatment with intraperitoneal (i.p. injection of duloxetine or celecoxib at 1 h before formalin injection induced the dose-dependent inhibition on the second but not first phase pain responses. Combined administration of duloxetine and celecoxib showed significant analgesia for the second phase pain responses. Combination analgesia on the first phase was observed only with higher dose combination. A statistical difference between the theoretical and experimental ED50 for the second phase pain responses was observed, which indicated synergistic interaction of the two drugs. Concerning the emotional pain responses revealed with USVs, we assumed that the antinociceptive effects were almost completely derived from duloxetine, since celecoxib was ineffective when administered alone or reduced the dosage of duloxetine when given in combination. Based on the above findings, acute concomitant administration of duloxetine and celecoxib showed synergism on the somatic pain behavior but not emotional pain behaviors.

  14. Functional brain interactions that serve cognitive-affective processing during pain and placebo analgesia.

    Science.gov (United States)

    Craggs, Jason G; Price, Donald D; Verne, G Nicholas; Perlstein, William M; Robinson, Michael M

    2007-12-01

    Pain requires the integration of sensory, cognitive, and affective information. The use of placebo is a common methodological ploy in many fields, including pain. Neuroimaging studies of pain and placebo analgesia (PA) have yet to identify a mechanism of action. Because PA must result from higher order processes, it is likely influenced by cognitive and affective dimensions of the pain experience. A network of brain regions involved in these processes includes the anterior and posterior insula (A-Ins, P-Ins), dorsal anterior cingulate cortex (DACC), dorsolateral prefrontal cortex (DLPFC), and the supplementary motor area (SMA). We used connectivity analyses to investigate the underlying mechanisms associated with Placebo analgesia in a group of chronic pain patients. Structural equation models (SEM) of fMRI data evaluated the inter-regional connectivity of these regions across three conditions: (1) initial Baseline (B1), (2) placebo (PA), and (3) Placebo Match (PM). SEM results of B1 data in the left hemisphere confirmed hypothesized regional relationships. However, inter-regional relationships were dynamic and the network models varied across hemispheres and conditions. Deviations from the B1 model in the PA and PM conditions correspond to our manipulation of expectation for pain. The dynamic changes in inter-regional influence across conditions are interpreted in the context of a self-reinforcing feedback loop involved in the induction and maintenance of PA. Although it is likely that placebo analgesia results partly from afferent inhibition of a nociceptive signal, the mechanisms likely involve the interaction of a cognitive-affective network with input from both hemispheres. PMID:17904390

  15. A case of trigeminal hypersensitivity after administration of intrathecal sufentanil and bupivacaine for labor analgesia

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    Adriano Bechara de Souza Hobaika

    2014-01-01

    Full Text Available Rostral spread of intrathecal drugs and sensitization of supraspinal sites may provoke several adverse effects. This case describes a patient with right hemifacial paresthesia, trismus and dysphasia on the trigeminal nerve distribution after intrathecal sufentanil administration. Primigravida, 34 years, 39 weeks of pregnancy, with hypothyroidism and pregnancy induced hypertension. Allergic to latex. In the use of puran T4, 50 μg /day. When the patient presented cervical dilatation of 4 cm, she requested analgesia. She was placed in the sitting position and a spinal puncture was performed with a 27G needle pencil point in L4/L5 (1.5 mg of bupivacaine plus 7.5 μg of sufentanil. Next, was performed an epidural puncture in the same space. It was injected bupivacaine 0.065%, 10 ml, to facilitate the passage of the catheter. After 5 min lying down in the lateral upright position, she complained of perioral and right hemifacial paresthesia, mainly maxillary and periorbital, as well as trismus and difficulty to speak. The symptoms lasted for 30 min and resolved spontaneously. After 1 h, patient requested supplementary analgesia (12 ml of bupivacaine 0.125% and a healthy baby girl was born. Temporary mental alterations have been described with the use of fentanyl and sufentanil in combined epidural-spinal analgesia, such as aphasia, difficulty of swallowing, mental confusion and even unconsciousness. In this patient, facial areas with paresthesia indicated by patient appear in clear association with the ophthalmic and maxillary branches of the trigeminal nerve and the occurrence of trismus and dysphagia are in association with the mandibular motor branch. The exact mechanism of rostral spread is not known, but it is speculated that after spinal drug administration, a subsequent epidural dose may reduce the intratecal space and propel the drug into the supraspinal sites.

  16. Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient

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    Jamil S Anwari

    2015-01-01

    Full Text Available Background: Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™ analgesia as bridging analgesia for epidural placement. Materials and Methods: Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction cycle, pain, Richmond Agitation Sedation Scale (RASS, nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded. Results: The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001, and continued to decrease significantly over the study period (P < 0.0001. The RASS scores continuously improved after each cycle (P < 0.0001. Only 1 parturient from the cohort became lightly sedated (RASS = −1. Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment. Conclusion: Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient.

  17. Post operative analgesia after incisional infiltration of bupivacaine v/s bupivacaine with buprenorphine

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    Tanu R Mehta

    2011-01-01

    Full Text Available Introduction: Opioid receptors have been demonstrated in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioid is believed to result in analgesia. Aim: To evaluate whether buprenorphine added to bupivacaine for wound infiltration can enhance post-operative analgesia via peripheral mechanisms. Materials and Methods: Forty ASA I and II adult patients scheduled for open donor nephrectomy were enrolled in this randomized double blind prospective study. In group A ( n=20 patients, the wound was infiltrated with bupivacaine 0.5% (2 mg/kg and in group B ( n=20 with bupivacaine 0.5% (2 mg/kg and buprenorphine (2 μg/kg. All patients were given diclofenac 75 mg IM at 8 h interval. Post-operative quality of analgesia was assessed by VAS (0-10 for 24 h and when VAS > 4 rescue analgesic was administered. Total dose of rescue analgesic and side effects were noted. Results: The time of administration of first rescue analgesic was significantly higher in group B (10.52±5.54 h as compared to group A (3.275±1.8 h. Mean VAS was significantly lower in group B as compared to group A. The total dosage of rescue analgesic was more in group A as compared to group B patients. Conclusion: Addition of buprenorphine to the local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 h, thus providing evidence in support of the existence of peripheral opioid receptors.

  18. Oral self-administration of buprenorphine in the diet for analgesia in mice.

    Science.gov (United States)

    Molina-Cimadevila, M J; Segura, S; Merino, C; Ruiz-Reig, N; Andrés, B; de Madaria, E

    2014-04-23

    Postsurgical oral self-administration of analgesics in rodents is an interesting technique of providing analgesia, avoiding the negative effects of manipulation. Several strategies, using gelatin or nutella, have already been described. However, rodents require some habituation period to reach a good intake because of their neophobic behavior. The current study aimed to explore whether buprenorphine when mixed with an extruded diet offers a potential treatment option in the pain management of mice using a triple approach: by measuring the spontaneous intake in healthy animals; by using the hot-plate test; and finally by assessing the drug's ability to provide postoperative analgesia in a surgical intervention of moderate severity (intra-utero electroporation). Mice consumed during 20 hours, similar amounts of extruded diet alone, mixed with glucosaline, and mixed with buprenorphine (0.03 mg per pellet) or meloxicam (0.25 mg per pellet) both of which were diluted in glucosaline, showing that no neophobia was associated with these administrations. Relative increase from baseline latency (% maximal possible effect) in the hot-plate test at 20 h of administration was significantly higher for oral buprenorphine in diet 0.03 mg/pellet, and diet 0.15 mg/pellet, compared with placebo and no differences were found between those oral administrations and subcutaneous buprenorphine 0.1 mg/kg measured 3 h later. The treatment was also effective in attenuating the reductions in food consumption and body weight that occur after surgery. These data suggest that providing buprenorphine with the diet is a feasible and effective way of self-administration of analgesia in mice and does not cause neophobia and may easily contribute to the refinement of surgical procedures. PMID:24759572

  19. Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries

    Directory of Open Access Journals (Sweden)

    Niveditha Padma Meenakshi Karuppiah

    2016-01-01

    Full Text Available Background and Aims: Caudal block (CB with adjuvants is routinely used in children for anaesthesia. We evaluated the efficacy of the α2 adrenergic agonist, dexmedetomidine at two different doses as an adjuvant to bupivacaine in CB. Methods: This study was conducted on ninety children. Control group BD0 received 0.25% bupivacaine 1 ml/kg, whereas, the study groups BD1 and BD2 received 1 μg/kg and 2 μg/kg dexmedetomidine, respectively, with 0.25% bupivacaine 1 ml/kg as a single shot CB. Adequacy of the block, haemodynamic changes, duration of analgesia and side effects were compared. Analysis of Variance was used for between-group comparisons of numerical variables. Student's t-test and Mann–Whitney U-test were used for quantitative data. Results: The demography was comparable. Anal sphincter 5 min after administration of the CB was relaxed in 89.3%, 82.1% and 75% of cases in BD0, BD1 and BD2 groups, respectively. The sphincter was relaxed at the end of surgery in all the cases. Comparable haemodynamics was noted with significantly prolonged duration of analgesia in the groups BD1 (964.2 ± 309 min and BD2 (1152.6 ± 380.4 min compared to control (444.6 ± 179.4 min. While no complications were encountered in groups BD0 and BD1, bradycardia was observed in four cases of BD2 group with accompanied hypotension in one of them. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine improves the quality of CB, provides good operating conditions and increases the duration of post-operative analgesia. We conclude that 1 μg/kg is as effective as 2 μg/kg of dexmedetomidine and with a better safety profile.

  20. CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 李勇; 叶铁虎; 任洪智; 黄宇光; 罗爱伦

    2003-01-01

    Objective.To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia(PCEA)after pulmonary lobectomy. Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group(22 patients)or ropivacaine group(21 patients). In the tetracaine group,0.15% tetracaine was used for postoperative PCEA,while 0.3% ropivacaine was used in the ropiva-caine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale(VAS). Forced expired volume at the 1st second(FEV1.0),forced vital capacity(FVC),FEV1.0/ FVC and peak expired flow(PEF)were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study. Results. VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation,pulmonary function was reduced in both groups. However,there were no significant differences between the percentage of the changes of FEV1.0,FEV1.0/FVC and PEF in the two groups. There were also no significant differences between the percentage of the changes of heart rate,mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.Conclusions. The analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in pa-tient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

    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

  2. [Analgesia in labor with continuous--drip venous perfusion of ketamine].

    Science.gov (United States)

    Bertoletti, P L; Ciucci, N

    1981-04-01

    A personal opinion on the way analgesia should be piloted in labour is expressed and reference is made to personal results with continuous venous drip perfusion of ketamin with a SIC P77 infusional pump in 110 cases. The data from the series are described and particular attention is given to the behaviour of the drug with respect to uterine dynamics and the incidence of instrumental intervention. Stress is laid on the considerable benefits offered by the method, including reduction of the labour period and good maternal and foetal tolerance.

  3. Ultrasound investigation central hemodynamics as a method of assessment effective analgesia in children

    OpenAIRE

    Dmytriieva, K. Y.

    2016-01-01

    Dmytriieva K. Y. Ultrasound investigation central hemodynamics as a method of assessment effective analgesia in children. Journal of Education, Health and Sport. 2016;6(6):207-212. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.55301 http://ojs.ukw.edu.pl/index.php/johs/article/view/3571   The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 239...

  4. Inhibiting pain with pain--A basic neuromechanism of acupuncture analgesia

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    (i) The structure and function of the meridian (chamd and collateral) described by ancient medical doctors may correspond to the blood circulation, nerve control and neurohumoral modulation of modern medicine. ( ii ) The needling, which can injure the tissue, is a noxious stimulation inducing pain. Acupuncture manipulation, such as lifting and thrusting, twisting and twirling, or electroacupuncturc (EA) with the sufferable biggest intensity for patients should be a stronger pain stimulation. The needling sensation of soreness, numbness, distension and heaviness is a deep pain.(iii) There is an intrinsic analgesic system in brain, which centers around the periventricular and periaqueductal grey matter, contains endorphins as possible mediators, goes through the descending inhibition system in medulla oblongata, and acts on the gating mechanism in spinal cord. It could be producing analgesia while the system is activated.(iv) NRM might be a supraspinal center modulating pain,and the R-S neurons could form a basic circuit of negative feedback modulating pain. The discovery of excitatory-inhibitory reversible R-S neurons may give a neurophysiological explanation for the double direction modulation of acupuncture at acupoint. (v) Non-noxious stimulation such as massage or stroking could excite type Ⅰ and Ⅱ afferent fibers, producing a weaker and transient analgesia through the spinal mechanism. When the acupoint is near the pain area, the afferent information from them could be converged on the same and neighboring spinal segments, the light acupuncture or low intensity of EA also has analgesic effects, showing acupoint specificity. But the acupoint specificity is not limited in a specialiy designated channel line, and it is closely related to the segment of innervation. (vi) While acupuncture manipulation of lifting and thrusting, twisting and twirling or a high intensity of EA is used, because the intensities of these stimulations exceed the threshold of afferent

  5. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D;

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P ....01) but significantly lower pain scores during rest (P anaesthesia received antiemetics (13 vs five; P epidural-spinal anaesthesia...

  6. Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation

    DEFF Research Database (Denmark)

    Møiniche, S; Bülow, Steffen; Hesselfeldt, Peter;

    1995-01-01

    unselected patients (median age 69 years) undergoing colonic resection. INTERVENTIONS: Patients received combined epidural and general anaesthesia during operations and after operation were given continuous epidural bupivacaine 0.25%, 4 ml hour and morphine 0.2 mg hour, for 96 hours and oral paracetamol 4 g......OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17...

  7. Comparison of Effect of Intrathecal Sufentanil-Bupivacaine and Fentanyl-Bupivacaine Combination on Postoperative Analgesia

    Directory of Open Access Journals (Sweden)

    Ishwar Singh

    2008-01-01

    Full Text Available Fifty ASA grade I/II patients scheduled for elective lower abdominal, lower limb and urological procedures were divided into two groups of 25 each .The first group (Group S received 2.5 ml of heavy bupivacaine with 0.2. ml sufentanil made up to 3 ml with saline. The second group (Group F received 2.5 ml of heavy bupivacaine with 0.5 ml of fentanyl. From our study it can be concluded that bupivacaine sufentanil combination although had shorter onset of action, but had more side effects especially nausea, vomiting and headache. The time for rescue analgesia in both groups was however similar.

  8. Effect of Age, Adernaline and Operation Site on Duration of Caudal Analgesia in Paediatric Patients

    OpenAIRE

    Kharirat Mohd., Yasir,G.A.Mir

    2003-01-01

    The effect ofage, operative site and addition of 1: 200,000 adrenaline to bupivacaine was evaluatedon the duration ofpost operative analgesia after caudal block in 200 children between the age groupof 1 year to 14 years. Anaesthesia was induced and maintained on Halothane/N20I02• After thiscaudal block was performed with 0.5 mllkg of0.25% bupivacaine in one group of 100 Children andwith 0.25% bupivacaine with adrenaline 1 : 200,000 in another 100 children. The duration of postoperative analge...

  9. Intravenous patient-controlled analgesia to manage the postoperative pain in patients undergoing craniotomy

    OpenAIRE

    Na, Hyo-Seok; An, Sang-Bum; Park, Hee-Pyoung; Lim, Young-Jin; Hwang, Jung-Won; Jeon, Young-Tae; Min, Seong-Won

    2011-01-01

    Background This randomized controlled study evaluated the efficacy of intravenous patient-controlled analgesia (IV-PCA) with fentanyl and ketorolac for neurosurgical patients, and compared the effectiveness of IV-PCA with intermittent analgesics injection. Methods The patients undergoing craniotomy were randomly assigned to two groups. Patients of group P (n = 53) received fentanyl (0.2 µg/kg/hr) and ketorolac (0.3 mg/kg/hr) via IV-PCA, and those of group N (n = 53) received intermittent fent...

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

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2015-01-01

    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.

  11. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

    Directory of Open Access Journals (Sweden)

    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  12. Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas Post-surgical analgesia in hip surgery: A comparison of three techniques

    Directory of Open Access Journals (Sweden)

    M.I. Segado Jiménez

    2010-09-01

    Full Text Available Introducción: Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos: Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, inicio de rehabilitación y costes económicos en cada grupo. Pacientes y método: Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en 3 grupos aleatorios: A: solo analgesia intravenosa, B: bloqueo iliofascial y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y satisfacción analgésica, tiempo transcurrido hasta el inicio de la sedestación, necesidad de analgésicos postoperatorios, efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados: La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (EVA medio 2,14±1,24, satisfacción 3,75±0,8 que en los que solo recibieron analgesia intravenosa (EVA medio 5,57±0,64, satisfacción 2,83±0,7 (pIntroduction: The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives: Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods: Prospective study of 90 patients undergoing hip surgery

  13. Thidiazuron affects the quality of 'Gala' apples stored under controlled atmosphere Thidiazuron afeta a qualidade de maçãs 'Gala' armazenadas sob atmosfera controlada

    Directory of Open Access Journals (Sweden)

    Ricardo Fabiano Hettwer Giehl

    2010-04-01

    Full Text Available This work was carried out aiming to evaluate the effect of thidiazuron (TDZ on the quality of 'Gala' apples stored under controlled atmosphere (CA conditions. Plants were sprayed at full bloom with TDZ at 0, 10, 20, or 40g ha-1 (a.i.. Harvested fruits were then stored in CA with 1.0+2.5, 1.5+2.5 and 1.5+5.0 (kPa O2+kPa CO2, both at 0.5°C. In addition, the partial pressure of 1.5kPa of O2+2.5kPa of CO2 was also evaluated at -0.5°C. Higher flesh firmness and titratable acidity was obtained by applying 20 or 40g ha-1 TDZ. Furthermore, these TDZ doses decreased the respiration rate as well as the occurrence of flesh breakdown, mealiness and decay. The application of TDZ at doses ranging from 20 to 40g ha-1 maintains higher fruit quality for up to 8 months under CA. In addition, the storage of 'Gala' apples under CA with 1.0kPa O2+2.5kPa CO2 at 0.5°C results in higher flesh firmness and titratable acidity. Moreover, this CA condition reduces the incidence of flesh breakdown, mealiness and postharvest decay in 'Gala' apple fruits.O objetivo deste trabalho foi avaliar o efeito da aplicação de thidiazuron (TDZ na qualidade de maçãs 'Gala' armazenadas em condições de atmosfera controlada (AC. Avaliou-se o efeito do TDZ nas doses de 0, 10, 20 e 40g ha-1 (i.a., aplicadas no pleno florescimento. Após a colheita, os frutos foram armazenados em condições de AC com 1,0+2,5; 1,5+2,5 ou 1,5+5,0 (kPa de O2+kPa de CO2, ambas a 0,5°C. Além disso, a pressão parcial de 1,5kPa de O2+2,5kPa de CO2 também foi avaliada a -0,5°C. Doses de TDZ entre 20 e 40g ha-1 mantiveram maior firmeza da polpa e acidez titulável. Além disso, essas mesmas doses reduziram a atividade respiratória e a incidência de degenerescência da polpa, de polpa farinhenta e de podridões. A aplicação pré-colheita de TDZ, especialmente em doses entre 20 e 40g ha-1, melhora a qualidade de maçãs 'Gala' armazenadas em AC por até oito meses. Em relação às condições de AC

  14. Efecto de la liberación controlada de nitrógeno sobre la fermentación y la degradabilidad in situ de Cynodon dactylon

    Directory of Open Access Journals (Sweden)

    Álvaro Ojeda

    2012-12-01

    Full Text Available Objetivo. Evaluar el efecto de una fuente no proteica de liberación controlada de nitrógeno (NnpLC sobre algunos parámetros de la fermentación ruminal y degradabilidad in situ de Cynodon dactylon. Materiales y métodos. 4 vacas fistuladas al rumen alimentadas con una dieta base de heno de Cynodon dactylon (4.8% proteína cruda y 78.4% fibra detergente neutra, 1 kg de melaza de caña y 55 g de mezcla mineral (tratamiento Control, y tratamientos experimentales con adición a la dieta base de 150 g urea (Urea, sustitución de Urea por NnpLC a razón de 50% del aporte de nitrógeno (Urea/ NnpLC y 183 g NnpLC (NnpLC. En un Cuadrado Latino 4x4 y períodos de 17 días, se registró consumo del día 7 al 14. El día 15 fueron tomadas muestras seriadas de contenido ruminal para evaluar pH, nitrógeno amoniacal (N-NH3 y ácidos grasos volátiles. La degradabilidad de la materia orgánica (DMO48 y fibra detergente neutro (DFND48 a las 48 h fueron medidas con bolsas de nylon. Resultados. No hubo diferencias (p>0.05 en consumo de materia seca (8.2±0.35 kgMS/animal/día, pH (6.1±0.21, DMO48 (52.2±6.2% y DFND48 (30.1±2.8%; aunque hubo diferencias (p<0.01 en valores medios de N-NH3 (19.1, 166.7, 181.6 y 281.8 mg/L; respectivamente. NnpLC incrementó (p<0.05 el ácido propiónico (27.3%, redujo el T1/2 (13.2% y optimizó la relación P:E (22.0± 0.76. Conclusiones. El uso de una fuente NnpLC generó un perfil de ácidos grasos volátiles con patrón gluconeogénico, optimizó la concentración de N-NH3 y mejoró la relación P:E, por lo que debe considerarse una alternativa para manipular el medio ambiente ruminal de vacunos alimentados con recursos fibrosos.

  15. Estimulação ovariana controlada e inseminação intrauterina: uma terapia atual? Controlled ovarian stimulation and intrauterine insemination: an actual therapy?

    Directory of Open Access Journals (Sweden)

    Joana Palmira Martins Almeida

    2011-11-01

    Full Text Available OBJETIVO: Analisar a taxa de gravidez na inseminação intrauterina (IIU, aferindo eventuais fatores prognósticos de sucesso. MÉTODOS: Estudo retrospectivo de ciclos de IIU ocorridos de janeiro de 2007 a julho de 2010 em uma Unidade de Medicina da Reprodução do Hospital Vila Nova de Gaia. Os ciclos foram precedidos por estimulação ovárica controlada e monitorizada por ecografia endovaginal. Avaliou-se a taxa de gravidez em função da idade da mulher, tipo e duração da infertilidade, motilidade no espermograma, número de folículos e fármaco usado na estimulação ovárica. A análise estatística foi efetuada com o Statistical Package for the Social Sciences (SPSS 17, com um nível de significância 5% (pPURPOSE: To evaluate the pregnancy rate in intrauterine insemination (IUI, and to determine possible prognostic factors of successful pregnancy. METHODS: A retrospective study of IUI cycles performed in the Reproductive Medicine Unit of Vila Nova de Gaia Hospital, between January 2007 and July 2010. The IUI cycles were preceded by ovarian stimulation and monitored by vaginal ultrasound. Clinical pregnancy rates were analyzed according to the woman’s age, type and duration of infertility, spermatozoa parameters assessed in the spermogram, number of mature follicles and the drug used for ovarian stimulation. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS17, with the level of significance set at p<0.05. RESULTS: The study comprised 139 couples who underwent 220 IUI cycles. The absolute pregnancy rate per cycle was 18.6%. Of the 41 clinical pregnancies, 5 were twin pregnancies (12.1%. The pregnancy rate was higher at ages <30 years (28.5 vs 15.7%; p=0.024, duration of infertility <3 years (23.8 vs 13.9%; p=0.05, normal sperm motility (23.2 vs 10.3%; p=0.01 and with two follicles at the time of insemination (27.7 vs 14.2% for monofollicular growth; p=0.030. The pregnancy rates obtained

  16. Infarto cerebral em duas crianças infectadas pelo HIV-1

    Directory of Open Access Journals (Sweden)

    Rocha Cristiane

    2003-01-01

    Full Text Available Os quadros vasculares são incomuns não somente nos pacientes adultos (1% como também nas crianças. Nosso objetivo é alertar para a possibilidade da infecção pelo HIV-1 em crianças com manifestações cerebrovasculares. Das 204 crianças infectadas pelo HIV acompanhadas no Ambulatório de SIDA, descrevemos dois pacientes pré-escolares do gênero masculino, com quadro agudo febril, rebaixamento do nível de consciência, status epilepticus e hemiparesia como primeira manifestação de infecção pelo HIV-1. Nos dois casos evidenciou-se extensa isquemia em território da artéria cerebral média. Um dos pacientes evoluiu com tetraparesia espástica grave, sem contactuar com o meio, epilepsia parcial e óbito 4 anos após o diagnóstico, sem melhora do quadro neurológico. O outro paciente apresentou hemiparesia direita e afasia global, evoluindo com regressão completa do quadro neurológico. A infreqüência desses achados torna importante o seu relato, visando a inclusão da infecção pelo HIV-1 no diagnóstico diferencial das quadros cerebrovasculares na criança.

  17. Os encantos da Veneza Americana e da propaganda pelo cinema: os filmes financiados pelo governo Sergio Loreto em Pernambuco (1922-1926

    Directory of Open Access Journals (Sweden)

    Luciana Corrêa de Araújo

    2013-06-01

    Full Text Available Este artigo aborda a produção cinematográfica financiada pelo governo Sergio Loreto em Pernambuco (1922-1926. Por meio de textos históricos, pesquisa em periódicos e análise fílmica, pretendemos destacar a relevância do estímulo oficial ao incipiente meio cinematográfico local e analisar como se constroem, nos filmes, as relações entre estratégias de propaganda e procedimentos estéticos e narrativos.

  18. The effect of etoricoxib premedication on postoperative analgesia requirement in orthopedic and trauma patients

    International Nuclear Information System (INIS)

    We have hypothesized that etoricoxib premedication would reduce the need for additional opioids following orthopedic trauma surgery. A double blind, controlled study, conducted in King Fahd University Hospital, King Faisal University, Dammam, Kingdom of Saudi Arabia. After obtaining the approval of Research and Ethics Committee and written consent, 200 American Society of Anesthesiology grade I and II patients that underwent elective upper limb or lower limb fracture fixation surgeries during the period from August 2005 to October 2007 were studied. Patients were randomly premedicated using 120 mg of etoricoxib or placebo n=100, each. To alleviate postoperative pain, a patient controlled analgesia device was programmed to deliver one mg of morphine intravenously locked lockout time, 6 minutes. Visual analog scale and total postoperative morphine consumption over 24 hours and the adverse effects were recorded. One hundred patients in each group completed the study period. Etoricoxib premedication provides a statistically significant postoperative morphine sparing effect over 24 hours postoperatively. Total morphine consumption was 44.2 (8.2) in the placebo and 35.17 mg in the etoricoxib groups p<0.001. The incidence of nausea and vomiting requiring treatment was lower in the etoricoxib group. p=0.014. The postoperative blood loss was similar in both groups. Etoricoxib is a suitable premedication before traumatic orthopedic surgery as it enhanced postoperative analgesia and reduced the need for morphine. (author)

  19. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  20. A prospective study of parents' compliance with their child's prescribed analgesia following tonsillectomy.

    LENUS (Irish Health Repository)

    Lennon, Paul

    2013-03-01

    We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg\\/kg\\/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg\\/kg\\/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg\\/kg\\/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.

  1. [Effects of epidural analgesia combined with general anesthesia on hemodynamics during neck surgery].

    Science.gov (United States)

    Arakawa, M; Amemiya, N; Nagai, K; Kato, S; Goto, F

    1993-10-01

    The aim of the present study was to investigate the effect of epidural analgesia combined with general anesthesia on hemodynamics. Thirty patients undergoing surgery for the treatment of cancer of the neck were studied. The patients were divided into two groups of those who received epidural analgesia combined with general anesthesia group (Group 1) and those with general anesthesia alone (Group 2). Blood pressure was not different between the groups. But heart rate and rate pressure products in Group 1 were significantly lower than those of Group 2. CVP in Group 1 increased significantly to 10.1 +/- 2.9 mmHg during surgery from 6.8 +/- 1.8 mmHg at the beginning of the surgery. There was no difference in intraoperative blood loss and the amount of fluid infused between the two groups. These results suggest that epidural anesthesia combined with general anesthesia is effective to stabilize hemodynamics during cervical surgery, but we have to be careful about using local anesthetics during long cervical procedures, because it increases CVP which might result from the depression of cardiac function. PMID:8230698

  2. The cognitive modulation of pain: hypnosis- and placebo-induced analgesia.

    Science.gov (United States)

    Kupers, Ron; Faymonville, Marie-Elisabeth; Laureys, Steven

    2005-01-01

    Nowadays, there is compelling evidence that there is a poor relationship between the incoming sensory input and the resulting pain sensation. Signals coming from the peripheral nervous system undergo a complex modulation by cognitive, affective, and motivational processes when they enter the central nervous system. Placebo- and hypnosis-induced analgesia form two extreme examples of how cognitive processes may influence the pain sensation. With the advent of modern brain imaging techniques, researchers have started to disentangle the brain mechanisms involved in these forms of cognitive modulation of pain. These studies have shown that the prefrontal and anterior cingulate cortices form important structures in a descending pathway that modulates incoming sensory input, likely via activation of the endogenous pain modulatory structures in the midbrain periaqueductal gray. Although little is known about the receptor systems involved in hypnosis-induced analgesia, studies of the placebo response suggest that the opiodergic and dopaminergic systems play an important role in the mediation of the placebo response. PMID:16186029

  3. Role of transcutaneous electrical nerve stimulation in post-operative analgesia

    Directory of Open Access Journals (Sweden)

    Sukhyanti Kerai

    2014-01-01

    Full Text Available The use of transcutaneous electrical nerve stimulation (TENS as non-pharmacological therapeutic modality is increasing. The types of TENS used clinically are conventional TENS, acupuncture TENS and intense TENS. Their working is believed to be based on gate control theory of pain and activation of endogenous opioids. TENS has been used in anaesthesia for treatment of post-operative analgesia, post-operative nausea vomiting and labour analgesia. Evidence to support analgesic efficacy of TENS is ambiguous. A systematic search of literature on PubMed and Cochrane Library from July 2012 to January 2014 identified a total of eight clinical trials investigating post-operative analgesic effects of TENS including a total of 442 patients. Most of the studies have demonstrated clinically significant reduction in pain intensity and supplemental analgesic requirement. However, these trials vary in TENS parameters used that is, duration, intensity, frequency of stimulation and location of electrodes. Further studies with adequate sample size and good methodological design are warranted to establish general recommendation for use of TENS for post-operative pain.

  4. COMPARISON OF PATIENT-CONTROLLED ANALGESIA WITH TRAMADOL VS MORPHINE IN PATIENTS UNDERGOING ABDOMINAL GYNECOLOGICAL SURGERY

    Institute of Scientific and Technical Information of China (English)

    龚志毅; 叶铁虎; 于广祥; 秦小涛

    2003-01-01

    Objective. To compare the analgesic efficacy and adverse effects of patient-controlled analgesia (PCA) with tramadol and with morphine for postoperative middle or severe pain. Methods. Fifty-nine patients, scheduled for elective hysterectomy or hysteromyomectomy, were ran domly divided into Group T (tramadol-treated group) and Group M (morphine-treated group). The 2 drugs were administered intravenously via a patient-controlled analgesia device till 24 h postoperatively. Efficacy was assessed by comparing total pain relief (TOTPAR) and the sum of pain intensity difference (SPID) values over 24 h. Results. Statistically significant equivalence of tramadol and morphine was shown by TOTPAR values (15.9+4.4 and 16.4+3.5, respectively) and SPID values (9.2+4.7 and 9.0±2.0, respectively) (P>0.05). Tramadol caused fewer adverse events than morphine(16.7% and 26.7% of patients, respectively). Conclusion. The analgesic efficacy of PCA with tramadol and with morphine were equivalent in the treatment of postoperative pain, and tramadol can cause slighter gastrointestinal adverse effects.

  5. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  6. Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica Obstetric epidural analgesia: failures and neurological complications of the technique

    Directory of Open Access Journals (Sweden)

    M. I. Segado-Jiménez

    2011-10-01

    Full Text Available Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%, punción hemática (8,7%, parestesias (8,2%, técnica dificultosa (5,2%, analgesia ineficaz (2,7%, hipotensión arterial (2,5% y bloqueo subdural (0,2%. En el postparto: lumbalgia (18,5%, retención urinaria (3,4%, cefalea post-punción dural (1,4%, neuropatías periféricas (0,9% e hipoestesia prolongada (0,2%. Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz.Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and

  7. Quantitative electroencephalographic analysis of the biphasic concentration-effect relationship of propofol in surgical patients during extradural analgesia

    NARCIS (Netherlands)

    Kuizenga, K; Kalkman, CJ; Hennis, PJ

    1998-01-01

    We studied effects on the EEG of propofol infused at a rate of 0.5 mg kg(-1) min(-1) for 10 min in 10 healthy male surgical patients under extradural analgesia. The EEG amplitude in six frequency bands was related to arterial blood propofol concentrations and responsiveness to verbal commands. The E

  8. Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy

    Directory of Open Access Journals (Sweden)

    Mesut Sener

    2015-12-01

    Full Text Available BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV paracetamol versus dipyrone via patient-controlled analgesia (PCA for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1 was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p 0.05. Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p 0.05. CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy.

  9. COMPARISION OF TWO DRUG COMBINATIONS FOR LABOUR ANALGESIA, AND ITS EFFECT ON PATIENT SATISFACTION, DURATION OF LABOUR AND FETAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Jaideep

    2014-09-01

    Full Text Available : BACKGROUND: Epidural is now established and accepted method to relief labour pain. This study intended to comparison of two drug combinations in labour analgesia and its effect on duration of labour, maternal satisfaction and fetal outcome. Combined epidural infusion of bupivacaine + fentanyl would result in analgesia superior to that provided by a continuous epidural infusion of a similar concentration of Bupivacaine alone. AIMS AND OBJECTIVE: To compare the efficacy of two drug combinations for labour analgesia, and its effect on patient satisfaction, duration of labour and fetal outcome. MATERIALS AND METHODS: Study design – comparative randomized controlled study. Sample size: For this study 50 pregnant women were randomly selected and divided into two groups. GROUP I: Control Group (Continuous epidural infusion of Bupivacaine CEI: 25 parturient who were given a bolus of 0.1% Bupivacaine + 20mcg Fentanyl followed by infusion of 0.0625% Bupivacaine epidurally. GROUP II: Study Group (Continuous epidural infusion of Bupivacaine with Fentanyl CEIF: 25 parturients who were given a bolus of 0.1% Bupivacaine + 20mcg Fentanyl followed by infusion of 0.0625% Bupivacaine + 0.0001% Fentanyl epidurally. Duration of labour, Analgesia, maternal satisfaction, fetal outcome was assessed by different scales like bromage scale, visual analogue scale, APGAR score and pin prick method are used. Side effects and complications, if present were recorded.

  10. Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy

    NARCIS (Netherlands)

    Fant, F.; Tina, E.; Sandblom, D.; Andersson, S. -O.; Magnuson, A.; Hultgren-Hornkvist, E.; Axelsson, K.; Gupta, A.

    2013-01-01

    Background. Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropu

  11. Foetal heart rate deceleration with combined spinal-epidural analgesia during labour: a maternal haemodynamic cardiac study.

    Science.gov (United States)

    Valensise, Herbert; Lo Presti, Damiano; Tiralongo, Grazia Maria; Pisani, Ilaria; Gagliardi, Giulia; Vasapollo, Barbara; Frigo, Maria Grazia

    2016-06-01

    To understand the mechanisms those are involved in the appearance of foetal heart rate decelerations (FHR) after the combined epidural analgesia in labour. Observational study done at University Hospital for 86-term singleton pregnant women with spontaneous labour. Serial bedside measurement of the main cardiac maternal parameters with USCOM technique; stroke volume (SV), heart rate (HR), cardiac output (CO) and total vascular resistances (TVR) inputting systolic and diastolic blood pressure before combined epidural analgesia and after 5', 10', 15' and 20 min. FHR was continuously recorded though cardiotocography before and after the procedure. Correlation between the appearance of foetal heart rate decelerations and the modification of maternal haemodynamic parameters. Fourteen out of 86 foetuses showed decelerations after the combined spino epidural procedure. No decelerations occurred in the women with low TVR (1200 dyne/s/cm(-5)). Soon after the epidural procedure, the absence of increase in SV and CO was observed in these women. No variations in systolic and diastolic blood pressure values were found. The level of TVR before combined epidural analgesia in labour may indicate the risk of FHR abnormalities after the procedure. Low TVR (<1000 dyne/s/cm(-5)) showed a reduced risk of FHR abnormalities. FHR decelerations seem to occur in women without the ability to upregulate SV and CO in response to the initial effects of analgesia. PMID:26333691

  12. EFFECT OF INTRAOPERATIVE ESMOLOL INFUSION ON POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS: A RANDOMISED CONTROLLED TR IAL

    OpenAIRE

    Shreya; Sabyasachi; Sekhar Ranjan

    2015-01-01

    BACKGROUND: Laparoscopic cholecystectomy, gaining worldwide popularity, can be performed on a short stay basis if postoperative pain is adequately addressed. Our present study determines the effect of intraoperative infusion of intravenous esmolol primarily in terms of postoperative analgesia and intraoperative haemodynamic stability. METHODS: 60 ASAPS 1 and 2 patients undergoing elective laparoscopic cholecystectomy were included in this randomi s ed, prospec...

  13. Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    孙立新

    2014-01-01

    Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)<30

  14. Uso da perfuração controlada na avaliação de degradação da madeira em edificações antigas : estudo de caso

    OpenAIRE

    Valle, Angela do; Brites, Ricardo D.; Lourenço, Paulo B.

    2006-01-01

    Este trabalho apresenta uma aplicação da técnica experimental de perfuração controlada como ferramenta auxiliar na estimativa do estado de deterioração de peças antigas de madeira. A inspeção visual é sempre necessária, mas às vezes não conclusiva. Nestes casos, o uso de uma técnica complementar contribui para uma melhor avaliação da seção residual da peça de madeira. Um método que possa ser aplicado de forma rápida, precisa e sem provocar danos na madeira é valioso instrumento no estudo d...

  15. Inibição da síntese da ACC (ácido 1-carboxílico-1-aminociclopropano) oxidase em maçãs frigoconservadas em atmosfera controlada

    OpenAIRE

    Zimmer, Paulo Dejalma; Jaqueline Dettmann BIERHALS; SILVA Jorge Adolfo; ROMBALDI Cesar Valmor

    1999-01-01

    Foi estudada a expressão da ACC oxidase em maçãs, cv. Jonagold, colhidas no estádio pré-climatérico e armazenadas sob refrigeração em atmosfera normal (0ºC, 95% UR - AN) e controlada (0ºC, 95% UR, 1,5% O2 e 2,5% CO2 - AC), durante 180 dias. Na instalação do experimento, aos 90 e aos 120 dias, foram coletadas amostras para a determinação da firmeza de polpa, da acidez total titulável, dos sólidos solúveis totais, da produção de etileno, da atividade ACC oxidase e para a detecção imunoquímica d...

  16. Efeito de tratamentos térmicos por imersão na qualidade de maçãs cv. Fuji inoculadas com Botryosphaeria dothidea e armazenadas em atmosfera controlada

    OpenAIRE

    Lunardi Rosângela; Seibert Eduardo; Pezzi Ernani; Casali Michel Elias; Bender Renar João

    2003-01-01

    O trabalho teve por objetivo avaliar a ocorrência de perdas qualitativas em maçãs cultivar Fuji, previamente inoculadas com o agente causal da podridão-branca (Botryosphaeria dothidea), durante armazenagem em atmosfera controlada (AC) de 1,2-1,6 kPa de O2 e 0,2-0,4 kPa de CO2 à temperatura de 0-1ºC. Os tratamentos foram combinações de 3 períodos (1; 2 ou 3 minutos) e 3 temperaturas da água de imersão (47; 49 ou 52ºC). As maçãs foram avaliadas após 1; 3 ou 5 meses em AC e mais 7 dias em temper...

  17. Controle de papuã (Urochloa plantaginea e produtividade de milho em solo argiloso através de formulação e doses de atrazina com liberação controlada

    Directory of Open Access Journals (Sweden)

    Eli Danieli Marchesan

    2013-11-01

    Full Text Available A utilização de herbicidas com formulações com liberação controlada poderá se constituir em uma ferramenta importante para reduzir problemas de lixiviação e garantir a eficácia desses produtos. O objetivo do presente trabalho foi comparar a eficiência de controle de Urochloa plantaginea (UROPL e o rendimento de grãos de milho entre uma formulação de atrazina comercial (WG e uma formulação de liberação controlada (xerogel. O delineamento utilizado foi o de blocos ao acaso, em parcelas subdivididas, com quatro repetições, em um esquema (2x7+1. Nas parcelas principais, foram locadas as formulações de atrazina (WG e xerogel e, nas subparcelas, as concentrações dos herbicidas (0, 2400, 3200, 3600, 4200, 5400 e 8000g de atrazina ha-1. Foram determinados os níveis de controle e densidade de plantas de UROPL e o rendimento de grãos da cultura do milho. A elevação das doses de atrazina resultou em aumento dos níveis de controle de UROPL. Em avaliações realizadas aos 28 e 35 dias após a aplicação, a atrazina xerogel demonstrou eficiência agronômica superior à formulação WG. Não ocorreram diferenças de rendimento de grãos de milho em parcelas tratadas com diferentes formulações e níveis de atrazina.

  18. Produção de mudas de espécies arbóreas nativas com combinações de adubos de liberação controlada e prontamente solúveis

    Directory of Open Access Journals (Sweden)

    Moraes Neto Sebastião Pires de

    2003-01-01

    Full Text Available O objetivo deste estudo foi testar diversas doses e fontes de adubo para verificar o crescimento de mudas de cinco espécies arbóreas nativas. As espécies utilizadas foram as pioneiras Guazuma ulmifolia (mutambo e Croton floribundus (capixingui, as secundárias iniciais Peltophorum dubium (canafístula e Gallesia integrifolia (pau-d'alho e a clímax Myroxylon peruiferum (cabreúva. Os tratamentos consistiram principalmente na utilização de adubo de liberação controlada (ALC, 19-06-10, N-P2O5-K2O de maneira pura ou em mistura com adubo em pó (AP, 14-16-18, ou AP mais adubação de cobertura periódica (ACP, 19-06-20, comparados com adubação convencional (adubação de base mais adubação de cobertura com sulfato de amônio e cloreto de potássio e testemunha (sem adubação. O substrato utilizado foi composto por 60% de húmus de minhoca, 30% de casca de arroz carbonizada e 10% de terra de subsolo, em base volumétrica. O recipiente que comportou o substrato foi o tubete de polipropileno de 50 cm³ de capacidade. Entre os tratamentos que produziram mudas de boa qualidade ao final do experimento, para cada espécie, aqueles com doses de 3,2 e 4,8 kg de adubo de liberação controlada por metro cúbico de substrato foram comuns a todas as espécies e, adicionalmente, resultaram em dimensões apropriadas para plantio no campo em menor tempo do que os outros tratamentos.

  19. Prolongation of post-operative spinal analgesia: A randomized prospective comparison of two doses of oral clonidine

    Directory of Open Access Journals (Sweden)

    Anita Kumari

    2014-01-01

    Full Text Available Background and Aims: Efforts to prolong analgesia with various intrathecal and oral adjuvants have been tried with varying success. The present study was aimed to explore and to compare the potential beneficial effects of prolongation of spinal analgesia with two different doses of oral clonidine. Materials and Methods: A randomized double-blind study was carried out among 60 (American Society of Anesthesiologists-I and II patients with aged range from 25 to 65 years undergoing lower abdominal surgery. They were divided randomly into three groups of 20 each. Group 1 patients were administered placebo whereas Group 2 and 3 received oral clonidine tablets (0.15 and 0.30 mg respectively 1-h prior to surgery. Subarachnoid block was administered as per standard protocol. Time to onset of analgesia at T-10, time to achieve maximum sensory level, dermatomal regression and time to rescue analgesia were observed. Side-effects such as hypotension, bradycardia, nausea and vomiting were noted. Statistical analysis was performed using ANOVA with post-hoc Students unpaired t-test and Chi-square test and value of P 0.05. Two segment regression was 78.3 ± 10.44 min, 150.2 ± 23.07 min and 149.3 ± 18.33 min in Groups 1-3 respectively. Time to rescue analgesia was significantly prolonged in Groups 2 and 3 compared with Group 1 (P < 0.05. Incidence of hypotension was higher in Group 2 (P < 0.05. Conclusion: Optimal dose of oral clonidine that produces clinically useful prolongation of spinal anesthesia using bupivacaine appears to be 0.15 mg when compared with 0.3 mg when overall efficacy is being compared.

  20. Chronic treatment with antidepressant drugs and the analgesia induced by 5-methoxy-N,N-dimethyltryptamine: attenuation by desipramine.

    Science.gov (United States)

    Danysz, W; Minor, B G; Post, C; Archer, T

    1986-08-01

    The effect of chronic and acute oral or intraperitoneal treatment with the antidepressant drugs, desipramine, amitriptyline, alaproclate and iprindole, upon pain thresholds in the tail flick, hot plate and shock titration tests of nociception in saline- and 5-MeODMT-treated rats was studied. Chronic desipramine treatment increased the pre-test tail flick latencies. In the saline-treated rats, chronic oral desipramine treatment increased tail flick latencies, whereas chronic oral amitriptyline treatment decreased tail flick latencies. In 5-MeODMT-treated rats, chronic oral desipramine treatment attenuated the effects of 5-MeODMT (1 mg/kg) in all three tests of nociception, whereas chronic amitriptyline caused a potentiation in the tail flick and hot plate tests. Chronic oral iprindole treatment attenuated 5-MeODMT-induced analgesia in the hot plate test. Chronic intraperitoneal desipramine treatment attenuated 5-MeODMT analgesia in the tail flick and shock titration tests. In a different chronic treatment experiment, oral desipramine treatment attenuated 5-MeODMT analgesia in the tail flick test and zimeldine did for both the tail flick and hot plate tests, whereas mianserin potentiated 5-MeODMT-induced analgesia in both the tail flick and hot plate tests. In the saline-treated rats, acute treatment with all four drugs, desipramine, amitriptyline, iprindole and alaproclate, elevated the shock thresholds, whereas in 5-MeODMT-treated rats, desipramine and amitriptyline elevated shock thresholds. Two main conclusions can be drawn: chronic desipramine caused a quite consistent attenuation of 5-MeODMT-induced analgesia and the effects of acute treatment differed strongly from that of the chronic treatment. The effects of chronic administration with these antidepressants were compared with other findings using different measures of behavioural and receptor function. PMID:3776549

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

    Directory of Open Access Journals (Sweden)

    Gabriela Carvalho Aquilino Santos

    2015-04-01

    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 mg.kg-1. 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 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im 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.

  2. The effects of desflurane and remifentanyl anaesthesia compared to lumbar epidural analgesia combined with desflurane on recovery

    Directory of Open Access Journals (Sweden)

    Celaleddin Soyalp

    2014-12-01

    Full Text Available Objective: Our primary objective in this study is to compare the effects of the applications of desflurane and remifentanyl anaesthesia, along with lumbar epidural analgesia combined with desflurane on postoperative recovery in the cases who undergoing lower abdominal surgery. Methods: This study performed 240 patients who undergoing elective lower abdominal surgery. Patients were divided into two random groups as Group DR (desflurane + remifentanyl n=120 and Group DL (desflurane +Lumbar Epidural Analgesia n=120.The general anaesthesia in Group DR was performed through the use of desflurane and remifentanyl. Group DL was administered a general anaesthesia through a pre-operative epidural catheter insertion and an application of desflurane. Extubation, eye opening, head lift for 5 seconds, and the surgical durations of the patients as well as the postoperative side-effects were recorded. Modified Aldrete Scoring System was used to assess the recovery of the patients from anaesthesia. Results: According to the inter group comparison results between Group DR and Group DL, the duration of extubation, eye opening, head lift for 5 seconds and the average amount of elapsed time until the modified Aldrete Scoring reached 10 were found statistically and significantly shorter in Group DL than Group DR( respectively p=0.002, p<0.001, p<0.001, p<0.001.The duration of the first analgesic need was statistically and significantly longer in Group DL compared to Group DR (p<0.001. The postoperative patient satisfaction in Group DL was statistically and significantly higher than that in Group DR (p=0.010. Conclusion: The Epidural analgesia included in the general anaesthesia in lower abdominal surgery is considered by us to be the beneficial and efficient method of analgesia which leads to an earlier recovery of the patients without affecting the intraoperative hemodynamic stability and which boosts the patient satisfaction by providing a more efficient analgesia

  3. A long-form α-neurotoxin from cobra venom produces potent opioidindependent analgesia

    Institute of Scientific and Technical Information of China (English)

    Zhi-xin CHEN; Hui-ling ZHANG; Zhen-lun GU; Bo-wen CHEN; Rong HAN; Paul F REID; Laurence N RAYMOND; Zheng-hong QIN

    2006-01-01

    Aim:In light of the antinociceptive activity of the short-chain neurotoxin,cobrotoxin,and other acetylcholine antagonists,the antinociceptive activity and mechanisms of cobratoxin (CTX) ,a long-chain postsynaptic α-neurotoxin,was investigated in rodent pain models.Methods:CTX was administered intraperitoneally (30,45,68μg/kg) ,intra-cerebral ventricularly (4.5 μg/kg) or microinjected into periaqueductal gray (PAG;4.5 μg/kg).The antinociceptive action was tested using the hot.plate and acetic acid writhing tests in mice and rats.The involvement of the cholinergic system and opioid system in CTX-induced analgesia was examined by pretreatment of animals with atropine (0.5 mg/kg,im;or 10 mg/kg,ip) or naloxone (1 and 5 mg/kg,ip).The effect of CTX on motor activity was tested using the Animex test.Results:CTX exhibited a dose-dependent analgesic action in mice as determined by both the hot-plate and acetic acid writhing tests.The Deak effect of analgesia was seen 3 h after administration.In the mouse acetic acid writhing test,the intra-cerebral ventricular administration of CTX at 4.5μg/kg (1/12th of a systemic dose) produced marked analgesic effects.Microinjection of CTX (4.5μg/kg) into the PAG region did not elicit an analgesic action in rats in the hot-plate test.Atropine at 0.5 mg/kg (im) and naloxone at l and 5 mg/kg (ip) both failed to block the analgesic effects of CTX,but atropine at 1 0 mg/kg (ip) did antagonize the analgesia mediated bv CTX in the mouse acetic acid writhing test.Acetylsalicylic acid (300 mg/kg) did not enhance the analgesic effects of CTX.At the highest effective dose of 68μg/kg the neurotoxin did not change the spontaneous mobility of mice.Conclusion:CTX has analgesic effects.which are mediated in the central nervous system though not through the PAG.The central cholinergic system but not opioid system appears to be involved in the antinociceptive action of CTX.

  4. Atmosfera controlada para o armazenamento da maçã 'Maxi Gala' Controlled atmosphere to the storage of 'Maxi Gala' apples

    Directory of Open Access Journals (Sweden)

    Anderson Weber

    2013-06-01

    Full Text Available Objetivou-se com este trabalho avaliar a qualidade da maçã 'Maxi Gala' submetida a diferentes combinações de níveis de O2 e CO2, temperaturas e perda de massa durante o armazenamento. O experimento foi conduzido em um delineamento inteiramente casualisado em esquema de parcelas subdivididas, com quatro repetições de 25 frutos. Os tratamentos originaram-se da combinação de diferentes condições de atmosfera controlada (AC em duas temperaturas (0,5 ºC e 1 ºC, que foram: (1 1,2 kPa O2 + 2,5 kPa CO2 + 3,5% de perda de massa (PM; (2 1,2 kPa O2 + 2,5 kPa CO2; (3 1,2 kPa O2 + 2,0 kPa CO2; (4 1,0 kPa O2 + 2,0 kPa CO2; (5 0,8 kPa O2 + 2,0 kPa CO2; e (6 0,8 kPa O2 + 1,5 kPa CO2. As melhores condições para o armazenamento da maçã 'Maxi Gala' foram as pressões parciais 0,8 a 1,0 kPa O2 associada com 2,0 kPa CO2 ou 0,8 kPa O2 com 1,5 kPa CO2 na temperatura de 1 ºC. Nessas condições ocorre maior manutenção da firmeza da polpa, redução na ocorrência de degenerescência senescente e a polpa farinácea. A perda de massa de 3,5% em AC com 1,2 kPa O2 + 2,5 kPa CO2 na temperatura de 1 ºC também é eficiente na manutenção da qualidade desta maçã.The objective of this study was to assess the quality of the 'Maxi Gala' apple under different mixtures of O2 and CO2, temperature and mass loss during storage. The experiment was carried out in a completely randomised design in a system of split-plots, with four replications of 25 fruits. The treatments, derived from the combination of various conditions of controlled atmosphere (CA at two temperatures (0.5 ºC and 1 ºC, were: (1 1.2 kPa O2 + 2.5 kPa CO2 + 3.5% mass loss (ML; (2 1.2 kPa O2 + 2.5 kPa CO2; (3 1.2 kPa O2 + 2.0 kPa CO2; (4 1.0 kPa O2 + 2.0 kPa CO2; (5 0.8 kPa O2 + 2.0 kPa CO2; and (6 0.8 kPa O2 + 1.5 kPa CO2. The best conditions for the storage of the 'Maxi Gala' apple were those with partial pressures of 0.8 to 1.0 kPa O2 associated with 2.0 kPa CO2 or 0.8 kPa O2 with 1.5 kPa CO

  5. Alta parasitemia pelo Trypanosoma cruzi em paciente com lupus eritematoso sistêmico

    OpenAIRE

    Santos-Neto Leopoldo Luiz dos; Polcheira Máira F.; Castro Cleudson; Lima Rodrigo Aires Corrêa; Simaan César Kozak; Corrêa-Lima Francisco Aires

    2003-01-01

    É descrito um caso de doença de Chagas com alta parasitemia pelo Trypanosoma cruzi em paciente com lupus eritematoso sistêmico. O xenodiagnóstico foi útil na identificação da parasitemia e o benznidazol foi capaz de reduzir a alta e incomum parasitemia. Em indivíduos com doenças auto-imunes e immunossuprimidos, o benznidazol pode ser uma alternativa no controle da alta parasitemia por Trypanosoma cruzi.

  6. Pseudoaneurismas em associacao com infeccao pelo virus da imunodeficiencia humana: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Guilon Otavio Santos Tenorio

    2013-09-01

    Full Text Available Os autores descrevem os casos de dois pacientes que apresentaram pseudoaneurismas e ressaltam a dificuldade diagnóstica e terapêutica por apresentar associação com a infecção pelo vírus da imunodeficiência humana, e também demonstram a semelhança com aneurisma sacular aterosclerótico da aorta abdominal

  7. Procedural sedation and analgesia in children undergoing digestive endoscopic procedures - paediatrician or anaesthesiologist?

    Science.gov (United States)

    Bartkowska-Śniatkowska, Alicja; Rosada-Kurasińska, Jowita; Ignyś, Iwona; Grześkowiak, Małgorzata; Zielińska, Marzena; Bienert, Agnieszka

    2014-01-01

    Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist.

  8. Procedural sedation and analgesia in children undergoing digestive endoscopic procedures – paediatrician or anaesthesiologist?

    Science.gov (United States)

    Rosada-Kurasińska, Jowita; Ignyś, Iwona; Grześkowiak, Małgorzata; Zielińska, Marzena; Bienert, Agnieszka

    2014-01-01

    Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist. PMID:25061486

  9. Labor analgesia for the parturient with lumbar tattoos: what does an obstetrician need to know?

    Science.gov (United States)

    Kuczkowski, Krzysztof M

    2006-08-01

    Tattoos-ancient forms of permanent body ornamentation (body art) have today become popular fashion accessories worldwide. More than 50% of all tattoos are being done on women. In the recent years body tattooing in unconventional sites (e.g. lumbar and/or sacral area, lower abdomen, breast, and buttocks) has gained increasing popularity among young women (including in pregnancy). Although, the potential hazards of regional anesthesia in patients with lumbar tattoos remain controversial it may seem prudent to avoid a hollow needle insertion (possible tissue entrapment in its bore as the needle passes to the deeper structures) through a tattoo for neuraxial blocks. This author is not aware of any other review articles in English literature discussing implications, and complications of labor analgesia in parturients presenting with lumbar tattoos.

  10. Heart-rate control during pain and suggestions of analgesia without deliberate induction of hypnosis.

    Science.gov (United States)

    Santarcangelo, Enrica L; Carli, Giancarlo; Migliorini, Silvia; Fontani, Giuliano; Varanini, Maurizio; Balocchi, Rita

    2008-07-01

    Heart rate and heart-rate variability (HRV) were studied through a set of different methods in high (highs) and low hypnotizable subjects (lows) not receiving any deliberate hypnotic induction in basal conditions (simple relaxation) and during nociceptive-pressor stimulation with and without suggestions of analgesia. ANOVA did not reveal any difference between highs and lows for heart rate and for the HRV indexes extracted from the series of the interbeat intervals (RR) of the ECG in the frequency (spectral analysis) and time domain (standard deviation, Poincare plot) in both basal and stimulation conditions. Factors possibly accounting for the results and likely responsible for an underestimation of group differences are discussed. PMID:18569137

  11. Impact of the CYP2D6 genotype on post-operative intravenous oxycodone analgesia

    DEFF Research Database (Denmark)

    Zwisler, S T; Enggaard, T P; Mikkelsen, S;

    2009-01-01

    Background: Oxycodone is a semi-synthetic opioid with a mu-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O-demethylation via the polymorphic CYP2D6. The aim of this study was to...... investigate whether CYP2D6 poor metabolizers (PMs) yield the same analgesia post-operatively from intravenous oxycodone as extensive metabolizers (EMs). Methods: Two hundred and seventy patients undergoing primarily thyroid surgery or hysterectomy were included and followed for 24 h post-operatively. The CYP2...... for the first time in patients that the oxymorphone formation depends on CYP2D6, but we found no difference in the post-operative analgesic effect of intravenous oxycodone between the two CYP2D6 genotypes....

  12. Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

    DEFF Research Database (Denmark)

    Stjernström, H; Henneberg, S; Eklund, A;

    1985-01-01

    anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection......Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general...... of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines...

  13. The effect of balanced analgesia on early convalescence after major orthopaedic surgery

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Hansen, B L;

    1994-01-01

    Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid...... and acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation...... of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care...

  14. APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

    Institute of Scientific and Technical Information of China (English)

    Hong Zhao; Tie-hu Ye; Zhi-yi Gong; Yang Xue; Zhang-gang Xue; Wen-qi Huang

    2005-01-01

    Objective To assess the efficacy and safety of lomoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patientcontrolled analgesia (PCA) in patients undergoing abdominal surgeries.Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lomoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058,respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).Conclusion In clinic, we can use lomoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.

  15. The 2015 Gerard W. Ostheimer Lecture: What's New in Labor Analgesia and Cesarean Delivery.

    Science.gov (United States)

    Arendt, Katherine W

    2016-05-01

    Every year the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review the literature pertinent to obstetric anesthesiology published the previous calendar year. This individual selects the most notable contributions, creates a syllabus of the articles, and then presents his/her overview in an annual lecture named in honor of the late Gerard W. Ostheimer, a pioneering obstetric anesthesiologist from the Brigham and Women's Hospital. This article reviews the literature published in 2014 focusing on the themes of labor analgesia and cesarean delivery. Its contents were presented as the Gerard W. Ostheimer Lecture at the 47th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, May 16, 2015, in Colorado Springs, Colorado. The syllabus is available as Supplemental Digital Content (http://links.lww.com/AA/B397).

  16. Labor analgesia for the parturient with lumbar tattoos: what does an obstetrician need to know?

    Science.gov (United States)

    Kuczkowski, Krzysztof M

    2006-08-01

    Tattoos-ancient forms of permanent body ornamentation (body art) have today become popular fashion accessories worldwide. More than 50% of all tattoos are being done on women. In the recent years body tattooing in unconventional sites (e.g. lumbar and/or sacral area, lower abdomen, breast, and buttocks) has gained increasing popularity among young women (including in pregnancy). Although, the potential hazards of regional anesthesia in patients with lumbar tattoos remain controversial it may seem prudent to avoid a hollow needle insertion (possible tissue entrapment in its bore as the needle passes to the deeper structures) through a tattoo for neuraxial blocks. This author is not aware of any other review articles in English literature discussing implications, and complications of labor analgesia in parturients presenting with lumbar tattoos. PMID:16491369

  17. Use of Neurofeedback to Enhance Response to Hypnotic Analgesia in Individuals With Multiple Sclerosis.

    Science.gov (United States)

    Jensen, Mark P; Gianas, Ann; George, Holly R; Sherlin, Leslie H; Kraft, George H; Ehde, Dawn M

    2016-01-01

    This proof of principle study examined the potential benefits of EEG neurofeedback for increasing responsiveness to self-hypnosis training for chronic pain management. The study comprised 20 individuals with multiple sclerosis (MS) who received 5 sessions of self-hypnosis training--1 face-to-face session and 4 prerecorded sessions. Participants were randomly assigned to have the prerecorded sessions preceded by either (a) EEG biofeedback (neurofeedback) training to increase left anterior theta power (NF-HYP) or (b) a relaxation control condition (RLX-HYP). Eighteen participants completed all treatment sessions and assessments. NF-HYP participants reported greater reductions in pain than RLX-HYP participants. The findings provide support for the potential treatment-enhancing effects of neurofeedback on hypnotic analgesia and also suggest that effective hypnosis treatment can be provided very efficiently. PMID:26599991

  18. Avaliação do broncoespasmo induzido pelo exercício avaliado pelo Peak Flow Meter em adolescentes obesos

    OpenAIRE

    Luciana Oliveira e Silva; Patrícia Leão da Silva; Ana Maria Oliveira Caixeta Nogueira; Morgana Borges Silva; Gabriela Costa Pontes Luz; Fernanda Veruska Narciso; Eliane Maria de Carvalho; Nadia Carla Cheik

    2011-01-01

    INTRODUÇÃO: Crianças e adolescentes com excesso de peso apresentam maior prevalência de broncoespasmo induzido pelo exercício (BIE), quando comparados a eutróficos. A espirometria e o peak flow meter são importantes métodos avaliativos da função pulmonar. Porém, a aplicabilidade do medidor do pico de fluxo expiratório (peak flow meter) na detecção do BIE em crianças e adolescentes com excesso de peso não é conhecida, o que justifica o desenvolvimento desta pesquisa. OBJETIVOS: Avaliar e compa...

  19. US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur [Akdeniz University School of Medicine, Department of Radiology (Turkey)

    2013-02-15

    Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1-10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

  20. Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

    Directory of Open Access Journals (Sweden)

    Shah Anand

    2007-01-01

    Full Text Available Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB. Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73 of patients received a continuous ISB; 11% (n=9 received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU, at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5, 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

  1. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Gadsden J

    2015-12-01

    Full Text Available Jeffrey Gadsden,1 Sabry Ayad,2 Jeffrey J Gonzales,3 Jaideep Mehta,4 Jan Boublik,5 Jacob Hutchins6,7 1Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, 3Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, 4Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, 5Department of Anesthesiology, NYU Langone Medical Center – Hospital for Joint Diseases, New York, NY, 6Department of Anesthesiology, 7Department of Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Transversus abdominis plane (TAP infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by

  2. Activation of Brainstem Pro-opiomelanocortin Neurons Produces Opioidergic Analgesia, Bradycardia and Bradypnoea

    Science.gov (United States)

    Hirschberg, Stefan; Hill, Rob; Balthasar, Nina; Pickering, Anthony E.

    2016-01-01

    Opioids are widely used medicinally as analgesics and abused for hedonic effects, actions that are each complicated by substantial risks such as cardiorespiratory depression. These drugs mimic peptides such as β-endorphin, which has a key role in endogenous analgesia. The β-endorphin in the central nervous system originates from pro-opiomelanocortin (POMC) neurons in the arcuate nucleus and nucleus of the solitary tract (NTS). Relatively little is known about the NTSPOMC neurons but their position within the sensory nucleus of the vagus led us to test the hypothesis that they play a role in modulation of cardiorespiratory and nociceptive control. The NTSPOMC neurons were targeted using viral vectors in a POMC-Cre mouse line to express either opto-genetic (channelrhodopsin-2) or chemo-genetic (Pharmacologically Selective Actuator Modules). Opto-genetic activation of the NTSPOMC neurons in the working heart brainstem preparation (n = 21) evoked a reliable, titratable and time-locked respiratory inhibition (120% increase in inter-breath interval) with a bradycardia (125±26 beats per minute) and augmented respiratory sinus arrhythmia (58% increase). Chemo-genetic activation of NTSPOMC neurons in vivo was anti-nociceptive in the tail flick assay (latency increased by 126±65%, pmelanocortin receptor antagonist). The NTSPOMC neurons were found to project to key brainstem structures involved in cardiorespiratory control (nucleus ambiguus and ventral respiratory group) and endogenous analgesia (periaqueductal gray and midline raphe). Thus the NTSPOMC neurons may be capable of tuning behaviour by an opioidergic modulation of nociceptive, respiratory and cardiac control. PMID:27077912

  3. Safety and efficacy of nurse-controlled analgesia in patients less than 1 year of age

    Directory of Open Access Journals (Sweden)

    Walia H

    2016-06-01

    Full Text Available Hina Walia,1 Dmitry Tumin,1 Sharon Wrona,1 David Martin,1,2 Tarun Bhalla,1,2 Joseph D Tobias,1-3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology and Pain Medicine, 3Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Background: The management of acute pain presents unique challenges in the younger pediatric population. Although patient-controlled devices are frequently used in patients ≥6 years of age, alternative modes of analgesic delivery are needed in infants.Objective: To examine the safety and efficacy of nurse-controlled analgesia (NCA in neonates less than 1 year of age.Methods: Data from patients <1 year of age receiving NCA as ordered by the Acute Pain Service at our institution were collected over a 5-year period and reviewed retrospectively. The primary outcomes were activation of the institution’s Rapid Response Team (RRT or Code Blue, signifying severe adverse events. Pain score after NCA initiation was a secondary outcome.Results: Among 338 girls and 431 boys, the most common opioid used for NCA was fentanyl, followed by morphine and hydromorphone. There were 39 (5% cases involving RRT or Code Blue activation, of which only one (Code Blue was activated due to a complication of NCA (apnea. Multivariable logistic regression demonstrated morphine NCA to be associated with greater odds of RRT activation (OR=3.29, 95% CI=1.35, 8.03, P=0.009 compared to fentanyl NCA. There were no statistically significant differences in pain scores after NCA initiation across NCA agents.Conclusion: NCA is safe in neonates and infants, with comparable efficacy demonstrated for the three agents used. The elevated incidence of RRT activation in patients receiving morphine suggests caution in its use and consideration of alternative agents in this population. Keywords: nurse-controlled analgesia, pain medicine, Rapid Response Team

  4. Comparison of two analgesia protocols for the treatment of pediatric orthopedic emergencies

    Directory of Open Access Journals (Sweden)

    Andrea Barcelos

    2015-08-01

    Full Text Available SummaryObjective:to compare the efficacy of two analgesia protocols (ketamine versus morphine associated with midazolam for the reduction of dislocations or closed fractures in children.Methods:randomized clinical trial comparing morphine (0.1mg/kg; max 5mg and ketamine (2.0mg/kg, max 70mg associated with midazolam (0.2mg/kg; max 10mg in the reduction of dislocations or closed fractures in children treated at the pediatrics emergency room (October 2010 and September 2011. The groups were compared in terms of the times to perform the procedures, analgesia, parent satisfaction and orthopedic team.Results:13 patients were allocated to ketamine and 12 to morphine, without differences in relation to age, weight, gender, type of injury, and pain scale before the intervention. There was no failure in any of the groups, no differences in time to start the intervention and overall procedure time. The average hospital stay time was similar (ketamine = 10.8+5.1h versus morphine = 12.3+4.4hs; p=0.447. The median pain (faces pain scale scores after the procedure was 2 in both groups. Amnesia was noted in 92.3% (ketamine and 83.3% (morphine (p=0.904. Parents said they were very satisfied in relation to the analgesic intervention (84.6% in the ketamine group and 66.6% in the morphine group; p=0.296. The satisfaction of the orthopedist regarding the intervention was 92.3% in the ketamine group and 75% in the morphine group (p=0.222.Conclusion:by producing results similar to morphine, ketamine can be considered as an excellent option in pain management and helps in the reduction of dislocations and closed fractures in pediatric emergency rooms.

  5. 浅谈分娩镇痛%Discussion on labor analgesia

    Institute of Scientific and Technical Information of China (English)

    雷道琴

    2015-01-01

    分娩是每个女性都需要经历的一个特殊生理过程,而大多数产妇在分娩过程中都会有分娩痛。分娩痛不仅会造成过度换气,使产妇出现呼吸性碱中毒,而且会影响产妇的胃肠道及膀胱动力,影响分娩过程的顺利进行。同时,分娩痛还会升高剖宫产率、升高新生儿窒息率,会对产妇日后的心理状态造成影响,影响胎儿的身体健康。因此,对产妇进行分娩镇痛至关重要。本文结合实际情况分析分娩镇的方法,以供参考。%Birth is a special physiological process of each female friends to experience, but most mothers in childbirth process will have labor pains.Labor pains will not only cause hyperventilation, easy to make maternalrespiratory alkalosis, and will influence the maternal gastrointestinal andbladder power, influence of delivery process. At the same time, labor painalso increased cesarean section rate, neonatal asphyxia rate rise, will affect the psychological status of pregnant women in the future, affect fetal health. Therefore, it was crucial to labor analgesia for parturient. In this paper, combined with the actual, talk about some views, for labor analgesia, in order to offer reference.

  6. Transdermal nitroglycerine enhances postoperative analgesia of intrathecal neostigmine following abdominal hysterectomies

    Directory of Open Access Journals (Sweden)

    Fareed Ahmed

    2010-01-01

    Full Text Available This study was carried out to assess the effect of nitroglycerine (transdermal on intrathecal neostigmine with bupivacaine on postoperative analgesia and note the incidence of adverse effects, if any. After taking informed consent, 120 patients of ASA Grade I and II were systematically randomised into four groups of 30 each. Patients were premedicated with midazolam 0.05 mg/kg intravenously and hydration with Ringer′s lactate solution 10ml/kg preoperatively in the holding room. Group I patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline and transdermal placebo patch. Group II patients received Intrathecal injection of 15 mg bupivacaine with 5 mcg of neostigmine and transdermal placebo patch. Group III patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline with transdermal nitroglycerine patch (5 mg/24 hours. Group IV patients received Intrathecal injection of 15 mg bupivacaine with 5mcg of neostigmine and transdermal nitroglycerine patch (5 mg/24 hours, applied on a non anaesthetised area after 20 minutes. Groups were demographically similar and did not differ in intraoperative characteristics like sensory block, motor block, haemodynamic parameters and SpO 2 . The mean duration of analgesia was 202.17 minutes, 407.20 minutes, 207.53 minutes and 581.63 minutes in control group (I, neostigmine group (II, nitroglycerine group (III and nitroglycerine neostigmine group (IV respectively (P< 0.01. To conclude, our results show that transdermal nitroglycerine itself does not show any analgesic potential but it enhances the analgesic potential of intrathecal neostigmine.

  7. Efeito da temperatura ambiente sobre o desempenho e características de carcaça de frangos de corte alimentados com dieta controlada e dois níveis de energia metabolizável Effect of environment temperature on performance and carcass characteristics in broilers pair-fed and two levels of metabolizable energy

    Directory of Open Access Journals (Sweden)

    Adhemar Rodrigues de Oliveira Neto

    2000-02-01

    Full Text Available RESUMO - O efeito da temperatura ambiente sobre desempenho e características de carcaça de frangos de corte alimentados com dieta controlada e dois níveis de energia metabolizável foi avaliado. Cento e sessenta frangos de corte machos Hubbard, de 21 dias de idade, com 791+4,12 g de peso médio inicial, foram alojados em ambiente com temperatura termoneutra (23,3±0,58ºC ou quente (32,3±0,31ºC até 42 dias de idade. O delineamento experimental foi inteiramente casualizado, em esquema fatorial 2 x 2 (nível de energia metabolizável [3075 e 3300 kcal de EM/kg] e temperatura ambiente [termoneutro e calor], com cinco repetições e oito aves por unidade experimental. As aves receberam iguais quantidades de ração nos dois ambientes. Ganho de peso e conversão alimentar foram influenciados negativamente pelo calor. Embora os pesos absolutos da carcaça e dos cortes (coxa, sobrecoxa, pernas e peito e o rendimento de peito dos frangos mantidos sob estresse de calor tenham reduzido, o rendimento de carcaça aumentou. Os pesos, absoluto e relativo, das penas foram menores para os animais mantidos no calor. Os pesos, absoluto e relativo, da gordura abdominal foram maiores para os frangos de corte criados no calor. A alta temperatura ambiente reduziu os pesos, absoluto e relativo, de coração, fígado, moela e intestinos, entretanto, o peso relativo dos pulmões e do proventrículo não foi influenciado. O estresse de calor influenciou negativamente o desempenho, reduziu o rendimento de peito e o peso de órgãos vitais, bem como aumentou a gordura abdominal de frangos de corte, independente do nível energético da ração.ABSTRACT - The effect of environmental temperature on performance and carcass characteristics in broilers pair-fed and two levels of metabolizable energy was evaluated. One hundred and sixty Hubbard male broilers, with 21 days of age and 791±4.12 g average initial weight were allotted either under thermoneutral environment (23

  8. Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva Anestesia venosa total en régimen de infusión objeto controlada: un análisis evolutivo Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2008-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921 e do tiopental (1934, a AVT evoluiu até o desenvolvimento da AVT com auxílio de bombas com infusão alvo-controlada (IAC. O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que era possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada.JUSTIFICATIVA Y OBJETIVOS: La anestesia venosa total (AVT tuvo diversos avances desde el inicio de la utilización de la técnica. Desde la síntesis de los primeros anestésicos venosos, con la introducción de los barbitúricos (1921 y del tiopental (1934, la AVT evolucionó hasta el desarrollo de la AVT con el auxilio de bombas con infusi

  9. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes

    Directory of Open Access Journals (Sweden)

    Keith A. Candiotti, MD

    2014-12-01

    Conclusions: Compared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy.

  10. Effects of a Hypnotic Induction and an Unpleasantness-Focused Analgesia Suggestion on Pain Catastrophizing to an Experimental Heat Stimulus: A Preliminary Study.

    Science.gov (United States)

    Adachi, Tomonori; Nakae, Aya; Sasaki, Jun

    2016-01-01

    Pain catastrophizing is associated with greater levels of pain. While many studies support the efficacy of hypnosis for pain, the effect on pain catastrophizing remains unclear. The present study evaluated the effect of hypnosis on pain catastrophizing using experimental heat stimulation. Twenty-two pain patients engaged in 3 conditions: baseline (no suggestion), hypnotic induction, and hypnotic induction plus analgesia suggestion. Participants with higher baseline pain showed a significant reduction in rumination following hypnotic induction plus analgesia suggestion and significant reductions in pain due to both the hypnotic induction alone and the hypnotic induction plus analgesia suggestion. The findings suggest that unpleasantness-focused hypnotic analgesia reduces pain via its effect on the rumination component of pain catastrophizing. PMID:27585727

  11. Relação entre a gravidade do trauma e padrões de analgesia utilizados em acidentados de transporte Relación entre la gravedad del trauma y los estándares de analgesia utilizados en accidentados de tránsito Relationship between trauma severity and analgesia standarts used in traffic accident victims

    Directory of Open Access Journals (Sweden)

    Ana Maria Calil

    2009-06-01

    Full Text Available Trata-se de um estudo inédito realizado no país, que identificou relações entre o padrão analgésico e a gravidade do trauma. Para tal, analisou-se uma população de 200 acidentados de transporte admitidos para tratamento na unidade de emergência de um hospital referência para o atendimento ao trauma no Município de São Paulo. A gravidade das lesões e do trauma foi caracterizada por índices de gravidade anatômicos. A partir da análise da terapia analgésica encontrada, construíram-se padrões de analgesia, tendo como base a escala analgésica da Organização Mundial de Saúde. Os resultados permitiram identificar associação estatística entre a gravidade do trauma e padrões distintos de analgesia. Espera-se que a divulgação desses achados possa servir de base para a criação de protocolos de analgesia em trauma e melhoria da qualidade da assistência, além de servir de estímulo para o desenvolvimento de estudos em uma área com tantas lacunas de conhecimento em nosso meio.Se trata de un estudio inédito, realizado en el país, que identificó relaciones entre el estándar analgésico y la gravedad del trauma. Para esto, se analizó una población de 200 accidentados en el tránsito, admitidos para tratamiento en una Unidad de emergencia de un hospital de referencia para la atención de traumas, en el Municipio de San Pablo. La gravedad de las lesiones y del trauma fue caracterizada por índices de gravedad anatómicos. Del análisis de la terapia analgésica encontrada se construyeron estándares de analgesia, teniendo como base la escala analgésica de la Organización Mundial de Salud. Los resultados permitieron identificar una asociación estadística entre la gravedad del trauma y los distintos estándares de analgesia. Se espera que la divulgación de lo encontrado pueda servir de base para crear protocolos de analgesia en traumas, mejorar la calidad de la asistencia y servir de estímulo para el desarrollo de

  12. High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated with Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

    DEFF Research Database (Denmark)

    Stenger, Michael; Fabrin, Anja; Schmidt, Henrik;

    2013-01-01

    The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.......The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome....

  13. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

    Directory of Open Access Journals (Sweden)

    V. Domingo

    2004-05-01

    Full Text Available Existe un interés creciente por la realización de los bloqueos de nervio periférico (BNP debido a sus potenciales beneficios como los concernientes a las interacciones de los fármacos anticoagulantes y los bloqueos neuroaxiales. Los BNP de la extremidad inferior, y sobre todo, los bloqueos periféricos del nervio ciático son el pariente pobre de las técnicas de anestesia regional y, en general, son poco conocidos y por tanto poco utilizados. En este artículo se realiza una revisión de los bloqueos del plexo lumbosacro, realizando especial énfasis en los bloqueos continuos mediante catéteres para analgesia postoperatoria y para el tratamiento del dolor crónico. La utilización de anestésicos locales de larga duración de acción, asociada a un escaso bloqueo motor, como es el caso de la ropivacaína, nos permite combinar técnicas de punción única para conseguir una adecuada analgesia intraoperatoria, con las técnicas de perfusión continua para analgesia postoperatoria. Es necesario un conocimiento anatómico preciso, así como de los territorios cutáneos de inervación de las ramas del plexo lumbosacro, para la realización de estas técnicas de bloqueo. La introducción de diferentes técnicas de imagen, fundamentalmente la ultrasonografía, para la localización de las estructuras nerviosas, facilita la realización de estos bloqueos y disminuye el riesgo de lesiones de los órganos adyacentes. La realización de los bloqueos continuos de nervio periférico ofrece el beneficio de una analgesia postoperatoria prolongada, con menores efectos adversos, mayor grado de satisfacción del paciente, y una recuperación funcional más rápida después de la cirugía.There is increasing interest in peripheral nerve blocks (PNB because of potential benefits relative to interactions of anticoagulants and central neuraxial techniques. Among all the regional anesthesia procedures, PNB of the lower limb, and specially sciatic nerve block

  14. Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

    Directory of Open Access Journals (Sweden)

    Giuseppe Borzellino

    2016-01-01

    Full Text Available Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06–2.08 without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program.

  15. Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies.

    Science.gov (United States)

    Borzellino, Giuseppe; Francis, Nader Kamal; Chapuis, Olivier; Krastinova, Evguenia; Dyevre, Valérie; Genna, Michele

    2016-01-01

    Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06-2.08) without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program. PMID:27642630

  16. Diagnóstico da Infecção pelo VIII na Criança

    OpenAIRE

    Infecção VIH na Criança, Recomendações do Grupo de Trabalho sobre a

    2014-01-01

    A infecção pelo VIH na criança, actualmente, no nosso país, é quase exclusivamente adquirida por via vertical.O primeiro passo é pois o da identificação da infecção na mãe, pelo que se recomenda a realização da serologia VIH em todas as grávidas (com consentimento informado).

  17. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials

    DEFF Research Database (Denmark)

    Carstensen, M; Møller, A M

    2010-01-01

    In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient......-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. Our primary aim was to compare the effectiveness and safety of postoperative administered ketamine in addition to opioid for i.v. PCA compared with i.v. PCA with opioid alone. Studies were identified from the Cochrane Library 2003...... of 4.5. Pain was assessed using visual analogue scales or verbal rating scales. Six studies showed significant improved postoperative analgesia with the addition of ketamine to opioids. Five studies showed no significant clinical improvement. For thoracic surgery, the addition of ketamine to opioid...

  18. Exposure to time varying magnetic fields associated with magnetic resonance imaging reduces fentanyl-induced analgesia in mice

    Energy Technology Data Exchange (ETDEWEB)

    Teskey, G.C.; Prato, F.S.; Ossenkopp, K.P.; Kavaliers, M.

    1988-01-01

    The effects of exposure to clinical magnetic resonance imaging (MRI) on analgesia induced by the mu opiate agonist, fentanyl, was examined in mice. During the dark period, adult male mice were exposed for 23.2 min to the time-varying (0.6 T/sec) magnetic field (TVMF) component of the MRI procedure. Following this exposure, the analgesic potency of fentanyl citrate (0.1 mg/kg) was determined at 5, 10, 15, and 30 min post-injection, using a thermal test stimulus (hot-plate 50 degrees C). Exposure to the magnetic-field gradients attenuated the fentanyl-induced analgesia in a manner comparable to that previously observed with morphine. These results indicate that the time-varying magnetic fields associated with MRI have significant inhibitory effects on the analgesic effects of specific mu-opiate-directed ligands.

  19. Development of the fentanyl iontophoretic transdermal system (ITS) for patient-controlled analgesia of postoperative pain management.

    Science.gov (United States)

    Minkowitz, Harold S; Danesi, Hassan; Ding, Li; Jones, James B

    2015-09-01

    The fentanyl iontophoretic transdermal system (ITS) is a needle-free, patient-activated drug delivery system used for patient-controlled analgesia in adult hospitalized patients with postoperative pain. The system design has been updated to a separated system consisting of a Controller and a Drug Unit, and has had regulatory submissions in USA and Europe in 2014. Fentanyl ITS has been shown to be therapeutically equivalent to morphine intravenous (iv.) patient-controlled analgesia. One of the advantages of fentanyl ITS is that patients have better mobility as there is no need for an iv. pump, iv. lines and pole. The introduction of the updated fentanyl ITS will add a versatile tool to the postoperative pain management armamentarium.

  20. Efeitos do óxido nitroso em hipotensão controlada durante anestesia com baixo fluxo Efectos del óxido nitroso en la hipotensión controlada durante la anestesia con bajo flujo The effects of nitrous oxide on controlled hypotension during low flow anesthesia

    Directory of Open Access Journals (Sweden)

    Semiha Barçın

    2013-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Investigamos o efeito do óxido nitroso (N2O em hipotensão controlada durante anestesia com baixo fluxo (isoflurano-dexmedetomidina em termos de hemodinâmica, consumo de anestésico e custos. MÉTODOS: Quarenta pacientes foram randomicamente alocados em dois grupos. Infusão de dexmedetomidina (0,1 µg.kg-1.min-1 foi mantida por 10 minutos. Subsequentemente, essa infusão foi mantida até os últimos 30 minutos de operação a uma dose de 0,7 µg.kg-1.hora-1. Tiopental (4-6 mg.kg-1 e brometo de vecurônio (0,08 0,12 mg.kg-1 foram administrados na indução de ambos os grupos. Isoflurano (2% foi administrado para manutenção da anestesia. O Grupo N recebeu uma mistura de 50% de O2-N2O e o Grupo A recebeu uma mistura de 50% de O2-ar como gás de transporte. Anestesia com baixo fluxo (1 L.min-1 foi iniciada após um período de 10 minutos de alto fluxo inicial (4,4 L.min-1. Os valores de pressão arterial, frequência cardíaca, saturação periférica de O2, isoflurano inspiratório e expiratório, O2 inspiratório e expiratório, N2O inspiratório e expiratório, CO2 inspiratório, concentração de CO2 após expiração e concentração alveolar mínima foram registrados. Além disso, as taxas de consumo total de fentanil, dexmedetomidina e isoflurano, bem como de hemorragia, foram determinadas. RESULTADOS: A frequência cardíaca diminuiu em ambos os grupos após a carga de dexmedetomidina. Após a intubação, os valores do Grupo A foram maiores nos minutos um, três, cinco, 10 e 15. Após a intubação, os valores de hipotensão desejados foram alcançados em 5 minutos no Grupo N e em 20 minutos no grupo A. Os valores da CAM foram mais altos no Grupo N nos minutos um, três, cinco, 10 e 15 (p JUSTIFICATIVA Y OBJETIVOS: Investigamos el efecto del óxido nitroso (N2O en hipotensión controlada durante anestesia con bajo flujo (isoflurano-dexmedetomidina en términos de hemodinámica, consumo de anestésico y costes

  1. Influência da época de colheita e do armazenamento em atmosfera controlada na qualidade da maçã 'Braeburn' Influence of harvest maturity and controlled atmosphere conditions on the quality of 'Braeburn' apple

    Directory of Open Access Journals (Sweden)

    Auri Brackmann

    2002-03-01

    Full Text Available Foi avaliado o efeito da época de colheita e das condições de armazenamento em atmosfera controlada sobre a firmeza da polpa, acidez titulável, ºBrix e, principalmente, sobre a ocorrência de degenerescência da polpa em maçãs (Malus domestica cv. Braeburn. Os tratamentos consistiram na combinação da data de colheita (27/3/1997 e 9/4/1997 com condição de armazenamento (temperatura de 0,5°C com: 1 kPa de O2/4,0 kPa de CO2; 1 kPa de O2/3,0 kPa de CO2; 1 kPa de O2/2,0 kPa de CO2; 21 kPa de O2/0,0 kPa de CO2, e temperatura de -0,5°C com: 1kPa de O2/3,0 kPa de CO2; 1 kPa de O2/2,0 kPa de CO2. Após oito meses de armazenamento, não foi observada suscetibilidade da maçã cv. Braeburn à baixa temperatura de armazenamento (-0,5ºC e os frutos armazenados em ambiente refrigerado apresentaram baixa qualidade para o consumo. As condições de atmosfera controlada de 1 kPa de O2 associadas com 2 e 3 kPa de CO2 e a -0,5ºC apresentaram menor incidência de podridões, rachaduras e degenerescência senescente. Os frutos colhidos tardiamente, em 9/4/1997, apresentaram maior incidência de podridões, polpa farinhenta, degenerescência com cortiça e rachaduras. Nos parâmetros firmeza da polpa, acidez titulável e teor de sólidos solúveis totais não se observaram diferenças entre as condições de atmosfera controlada, após sete dias de exposição à temperatura de 25ºC.This work was carried out to evaluate the effect of harvest maturity and controlled atmosphere on the quality and internal breakdown incidence in apples (Malus domestica cv. Braeburn. The treatments consisted in the combination of harvest maturity (March 27, 1997 and April 9, 1997 with storage conditions (0.5°C with: 1 kPa O2/4 kPa CO2; 1 kPa O2/3 kPa CO2; 1 kPa O2/2 kPa CO2; 21 kPa O2/0 kPa CO2-cold storage and; -0.5°C with: 1 kPa O2/3 kPa CO2; 1 kPa O2/2 kPa CO2. After eight months of storage, there was no low temperature injury on fruits stored at -0.5ºC, and the

  2. 硬膜外分娩镇痛的研究进展%Advances in epidural analgesia for labour

    Institute of Scientific and Technical Information of China (English)

    罗宝蓉; 李树人

    2008-01-01

    硬膜外分娩镇痛对分娩的影响一直存在争议.新近资料不仅提供了硬膜外分娩镇痛对产程、剖宫产率、阴道器械助产率、及新生儿影响的进展,而且它与持续性枕后位和产妇发烧的关系也受到关注.改进硬膜外分娩镇痛技术的关键是减小对分娩不利影响并保证产妇满意镇痛的重要手段.研究表明采用低浓度局麻药复合阿片类药硬膜外镇痛,设置大容量PCEA和长锁定时间的输注模式对分娩的影响最小.%Controversy has suspended about the influence of epidural analgesia on labour in past years. Recent literatures provide new findings not only about its influeuee on labour stages, the incidence of instrumental and operative delivery, and neonate safety, but also about its relation with fetal head position at delivery, and maternal pyrexia. To avoid mstoward effects on delivery and ensure sarisfactory analgesia during labor are the key points of success of labor analgesia. Studies show that patient-controlled epidural analgesia with a lower concentration of anesthetic, a higher bolus volume and a longer lockout interval had minimal influence on labour.

  3. Analgesia Is Enhanced by Providing Information regarding Good Outcomes Associated with an Odor: Placebo Effects in Aromatherapy?

    OpenAIRE

    Yuri Masaoka; Miho Takayama; Hiroyoshi Yajima; Akiko Kawase; Nobuari Takakura; Ikuo Homma

    2013-01-01

    No previous report has described whether information regarding an odor used in aromatherapy has placebo effects. We investigated whether placebo analgesia was engendered by verbal information regarding the analgesic effects of an odor. Twelve of 24 subjects were provided with the information that a lavender odor would reduce pain (informed), whereas the other 12 subjects were not (not-informed). Concurrent with respiration recording, the subjects were administered a lavender-odor or no-odor t...

  4. The Impact of Labour Epidural Analgesia on the Childbirth Expectation and Experience at a Tertiary Care Center in Southern India.

    OpenAIRE

    Bhatt, Hitanshu; Pandya, Sunil; Kolar, Geeta; Nirmalan, Praveen Kumar

    2014-01-01

    Background: Labour epidural analgesia is increasingly used as a means of pain relief for women during labour and delivery. The significant pain during labour and delivery can be terrifying for mothers-to-be and the prospect of relief from pain can help reduce fear of childbirth to an extent. However, it is not necessary that reduced fear of childbirth may lead to an increased satisfaction with the childbirth experience.

  5. Investigation of the Effects of Continuous Low-Dose Epidural Analgesia on the Autonomic Nervous System Using Hilbert Huang Transform

    Directory of Open Access Journals (Sweden)

    Wei-Ren Chuang

    2010-01-01

    Full Text Available Effects of continuous low-dose epidural bupivacaine (0.05-0.1% infusion on the Doppler velocimetry for labor analgesia have been well documented. The aim of this study was to monitor the activity of the autonomic nervous system (ANS for women in labor based on Hilbert Huang transform (HHT, which performs signal processing for nonlinear systems, such as human cardiac systems. Thirteen pregnant women were included in the experimental group for labor analgesia. They received continuous epidural bupivacaine 0.075% infusion. The normal-to-normal intervals (NN-interval were downloaded from an ECG holter. Another 20 pregnant women in non-anesthesia labor (average gestation age was 38.6 weeks were included in the comparison group. In this study, HHT was used to decompose components of ECG signals, which reflect three different frequency bands of a person's heart rate spectrum (viz. high frequency (HF, low frequency (LF and very low frequency (VLF. It was found that the change of energy in subjects without anesthesia was more active than that with continuous epidural bupivacaine 0.075% infusion. The energy values of the experimental group (i.e., labor analgesia of HF and LF of ANS activities were significantly lower (P < 0.05 than the values of the comparison group (viz. labor without analgesia, but the trend of energy ratio of LF/HF was opposite. In conclusion, the sympathetic and parasympathetic components of ANS are all suppressed by continuous low-dose epidural bupivacaine 0.075% infusion, but parasympathetic power is suppressed more than sympathetic power.

  6. Prediction of response to noxious stimulation during sedation-analgesia by refined multiscale entropy analysis of EEG

    OpenAIRE

    Valencia, Jose F.; Melia, Umberto Sergio Pio; Vallverdú Ferrer, Montserrat; Jospin, Mathieu; Erik W. Jensen; Porta, Alberto; Gambus, Pedro L.; Caminal Magrans, Pere

    2014-01-01

    The level of sedation in patients undergoing medical procedures evolves contin uously since the effect of the anesthetic and analgesic agents is counteracted by noxious stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this...

  7. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial

    DEFF Research Database (Denmark)

    Toftdahl, Karen; Nikolajsen, Lone; Haraldsted, Viggo;

    2007-01-01

    . No differences between groups were seen regarding side effects or length of stay. INTERPRETATION: Peri- and intraarticular application of analgesics by infiltration and bolus injections can improve early analgesia and mobilization for patients undergoing TKA. Further studies of optimal drugs, dosage...... of these substances through an intraarticular catheter. RESULTS: More patients in group I than in group F could walk consumption of opioids on the first postoperative day...

  8. The evaluation of efficacy and safety of paravertebral block for perioperative analgesia in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2012-01-01

    Full Text Available Background: Paravertebral block is a popular regional anesthetic technique used for perioperative analgesia in multiple surgical procedures. There are very few randomized trials of its use in laparoscopic cholecystectomy in medical literature. This study was aimed at assessing its efficacy and opioid-sparing potential in this surgery. Methods: Fifty patients were included in this prospective randomized study and allocated to two groups: Group A (25 patients receiving general anesthesia alone and Group B (25 patients receiving nerve-stimulator-guided bilateral thoracic Paravertebral Block (PVB at T6 level with 0.3 ml/kg of 0.25% bupivacaine prior to induction of general anesthesia. Intraoperative analgesia was supplemented with fentanyl (0.5 μg/kg based on hemodynamic and clinical parameters. Postoperatively, patients in both the groups received Patient-Controlled Analgesia (PCA morphine for the first 24 hours. The efficacy of PVB was assessed by comparing intraoperative fentanyl requirements, postoperative VAS scores at rest, and on coughing and PCA morphine consumption between the two groups. Results: Intraoperative supplemental fentanyl was significantly less in Group B compared to Group A (17.6 μg and 38.6 μg, respectively, P =0.001. PCA morphine requirement was significantly low in the PVB group at 2, 6, 12, and 24 hours postoperatively compared to that in Group A (4.4 mg vs 6.9 mg, 7.6 mg vs 14.2 mg, 11.6 mg vs 20.0 mg, 16.8 mg vs 27.2 mg, respectively; P <0.0001 at all intervals. Conclusion: Pre-induction PVB resulted in improved analgesia for 24 hours following laparoscopic cholecystectomy in this study, along with a significant reduction in perioperative opioid consumption and opioid-related side effects.

  9. Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

    OpenAIRE

    Min, Too Jae; Kim, Woon Young; Jeong, Won Ju; Choi, Jae Ho; Lee, Yoon Sook; Kim, Jae Hwan; Park, Young Cheol

    2012-01-01

    Background Nuss surgery is preferred in pectus excavatum repair because this procedure produces excellent cosmetic results and prevents postoperative distressed pulmonary function. However, the procedure causes severe pain due to thoracic expansion. This study was designed to investigate the analgesic effect of small doses of ketamine on an intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and ketorolac for pain control after Nuss surgery. Methods Forty-four patients under...

  10. Audio-analgesia and Multi-disciplinary Pain Management: A Psychological Investigation into Acute, Post-operative Pain

    OpenAIRE

    Finlay, Katherine Anne

    2009-01-01

    Background: Audio-analgesia, the ability of music to reduce the perception of pain, has been a significant field of research in the past decade. This study aimed to investigate the impact of the musical constructs of harmonicity and rhythmicity on acute, post-operative pain. Method: 98 patients scheduled for primary total knee arthroplasty were randomly allocated at their pre-admissions clinic to one of four music listening groups, receiving commercially-available music. The...

  11. Placebo analgesia and its underlying mechanisms%安慰剂镇痛及内在机制

    Institute of Scientific and Technical Information of China (English)

    张瑞睿; 郭建友

    2011-01-01

    安慰剂镇痛效应在常规临床实践中有着非常重要的作用和意义.有意识的预期过程及无意识的条件反射均能产生安慰剂镇痛效应,并影响相应的生理功能.安慰剂镇痛效应可以分为阿片和非阿片成分,这两类安慰剂镇痛效应可能涉及不同的通道、脑区及相关大脑回路.本文综述了产生安慰剂镇痛的机制及神经生理学研究进展,并提出今后的研究方向.%Placebo effect is a biological phenomenon with psychosocial-induced biochemical changes in a patient's brain and body. The term placebo-related effects aims to extend the concept of placebo effect to related phenomena and makes the underlying mechanisms better understood. The placebo analgesia effect is induced by different mechanisms, including the expectation of pain relief and conditioning. According to pharmacological studies, placebo analgesia is subdivided into opioid and non-opioid compo-nents while functional imaging data has also revealed brain regions and brain network involved in placebo analgesia. On the basis of previous research, this paper discussed the definition and underlying mechanisms of placebo analgesia, and gave some suggestions about related study in future.

  12. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    OpenAIRE

    Venkatraman R; Abhinaya RJ; Sakthivel A; Sivarajan G

    2016-01-01

    Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India Background and aim: Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our s...

  13. Psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy:A complementary approach to drug analgesia

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM:To assess whether psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy.METHODS:Two hundred and sixty-two patients,who required hepatic arterial chemoembolization for hepatic malignancy and postembolization pain,were randomized into control group(n = 46,receiving medication)and intervention group(n = 216,receiving psychological intervention and medication in turn).The symptom checklist-90 (SCL-90) was used to scale the psychological symptoms of the patients before operation.Pain was scored with a 0 to 10 numeric rating scale(NRS-10)before and after analgesia as well as after psychological intervention(only in intervention group).RESULTS:All psychological symptomatic scores measured with SCL-90 in the intervention group were higher than the normal range in Chinese (P < 0.05).The somatization,phobia and anxiety symptomatic scores were associated with pain numerical rating score before analgesia(r = 0.141, 0.157 and 0.192,respectively,P < 0.05).Patients in both groups experienced pain relief after medication,psychotherapy or psychotherapy combined with medication during the procedure (P < 0.01).Only some patients in the intervention group reported partial or entire pain relief (29.17% and 2.31%) after psychological intervention.The pain score after analgesia in the intervention group was significantly lower than that in the control group (P < 0.01).CONCLUSION:Severe psychological distress occurs in patients with hepatic malignancy.Psychological intervention reduces pain scores significantly during hepatic arterial chemoembolization therapy and is thus,highly recommended as a complementary approach to drug analgesia.

  14. Zinc involvement in opioid addiction and analgesia – should zinc supplementation be recommended for opioid-treated persons?

    OpenAIRE

    Ciubotariu, Diana; Ghiciuc, Cristina Mihaela; Lupușoru, Cătălina Elena

    2015-01-01

    Introduction Zinc chelators were shown to facilitate some opioid-withdrawal signs in animals. Zinc deficiency, which affects more than 15 % the world’s population, is also common among opioid consumers and opioid-treated animals exhibit misbalances of zinc distribution. Aim The present study focuses on how zinc ions interfere with opioid dependence/addiction and analgesia, trying to preliminary discuss if zinc supplementation in opioid-users should be recommended in order to reduce the risk o...

  15. A COMPARATIVE EVALUATION OF GABAPENTIN AND CLONIDINE PREMEDICATION ON POST OPERATIVE ANALGESIA REQUIREMENT FOLLOWING ABDOMINAL SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Ashish

    2014-08-01

    Full Text Available AIM: Aim of our study was to compare the relative effectiveness of gabapentin and clonidine premedication on patients undergoing elective abdominal surgeries under G.A. OBJECTIVE: gabapentine and clonidine have anti-nociceptive properties .This study assess their efficacy in prolonging the analgesic effect intra-operative and postoperative analgesic requirement. MATERIAL AND METHOD: 225 patients of either sex of age between 20-60 years, ASA grade I & II, patient admitted to Hamidia hospital for elective abdominal surgeries under general anaesthesia were included in the study. The patients were randomly allocated into three groups 75 each group I : Control group (patients received placebo tablet at 90 min before the surgery,group II Gabapentin 300 mg tablet orally 90 min before surgery ,groupIII:clonidine150µg tablet orally given 90 min before surgery. Duration of postoperative analgesia, Degree of postoperative pain (VAS scoreand added rescue analgesia required in 24 hrs were recorded postoperatively. RESULT: Analysis reveled that there was no difference in the HR, SBP among the three group during the study. Duration of postoperative analgesia, observed from time of reversal to first demand of analgesia in the recovery room was more in group II compared to group I and group III (p-value <0.001, highly significant. Pain perception was highly blunted in groups II compared to group I & group III. Total rescue analgesic requirement during the postoperative 24hrs period was much lower in group II inj Diclofenac compared to group I and group III . ( p-value < 0.001, highly significant.CONCLUSION: Given 90 min before induction of GA oral gabapentin(300 mg or clonidine(150 µg preoperatively was effective in lowering postoperative VAS pain score and consumption of analgesics, it was also shows that gabapentin significantly decreases postoperative pain intensity and analgesic consumption after abdominal surgeries.

  16. Clinical analysis of 150 cases of labor analgesia%分娩镇痛150例临床分析

    Institute of Scientific and Technical Information of China (English)

    张小平

    2015-01-01

    Objective to investigate the infiuence of labor analgesia on birth process, postpartum hemorrhage, labour style and neonatal asphyxia.Methods150 cases of maternal labor analgesia (analgesia group)and 150 cases of normal pregnant women(control group) in the same period were analyzed, birth proces,postpartum hemorrhage,labour style and maternal satisfaction, neonatal apgar score of two groups for comparison.Resultthe incidence of cesarean section in the analgesia group was lower than that in the control group,and the incidence of vaginal delivery was higher than that of the control group,and the difference between the two groups was statistically significant (P0.05).the Vas score of the analgesic group was lower than that in the control group (P0.05)。镇痛组用药后各时点 Vas评分低于对照组(P<0.05)。镇痛组产妇满意度明显高于对照组产妇满意度,两组间具有统计学差异(P<0.05)。结论分娩镇痛可以使产妇分娩疼痛有所减少,有助于缩短产程的时间,有助于增强产妇自然分娩的信心,促进产程顺利进行,降低新生儿窒息发生率。

  17. Analgesia and decrement in operant performance in socially defeated mice: selective cross-tolerance to morphine and antagonism by naltrexone.

    Science.gov (United States)

    Miczek, K A; Winslow, J T

    1987-01-01

    During a social confrontation between a resident and an intruder mouse, only the submissive or defeated intruder shows an opioid-mediated analgesia to which tolerance develops. We investigated the altered morphine responsiveness after different kinds of social experiences. Mice were assessed for performance of operant behavior under the control of a fixed ratio schedule of positive reinforcement as well as for the tail flick response to a heat stimulus before and after one or five consecutive social confrontations. The dose-effect curves for morphine's suppression of schedule-controlled behavior were closely similar before and after defeat in a single or in five social confrontations. However, the concurrently measured response to pain in the tail flick assay produced morphine dose-effect curves that were shifted to the right after defeat in one or five social confrontations. Four to six times higher doses of morphine were necessary to produce analgesia in mice that were defeated in five social confrontations. Naltrexone (1 mg/kg, ip) antagonized the suppressive effects of morphine (10 mg/kg, ip) on rate of responding and the analgesic effects. Naltrexone also blocked the development of analgesia in mice that were defeated for the first time in a social confrontation, but did not prevent the suppressive effects on rate of responding. Specific social experiences such as defeat in a social confrontation appear to alter endogenous opioid process that mediate analgesia; these processes differ from those that suppress positively reinforced behavior. The differential development of morphine tolerance to the analgesic effects, but not the rate-decreasing effects as well as the differential naltrexone antagonism of both effects may indicate the involvement of opioid and non-opioid mechanisms. PMID:3114797

  18. Eletroneuromiografia e potenciais evocados somatossensitivos na mielopatia pelo HTLV-I

    OpenAIRE

    CRUZ MÁRCIA WADDINGTON; CORRÊA ROSALIE BRANCO; PUCCIONI-SOHLER MÁRZIA; NOVIS SÉRGIO AUGUSTO PEREIRA

    1998-01-01

    Tivemos como objetivo investigar por eletroneuromiografia (ENMG) e potenciais evocados somatossensitivos a possibilidade de acometimento do nervo periférico na mielopatia pelo HTLV-I (HAM), correlacionando os achados com os parâmetos clínicos e com a síntese intratecal de anticorpos anti HTLV-I. Os pacientes tinham sorologia negativa para HIV e apresentaram VDRL negativo. Outras causas para mielopatia ou neuropatia periférica foram excluídas. De 32 pacientes que realizaram ENMG, em 34,3% ela ...

  19. Pseudoneoplastic lesion of the breast caused by Schistosoma mansoni Pseudoneoplasma da mama causado pelo Schistosoma mansoni

    OpenAIRE

    Carlos Anselmo Lima; Aécio Costa Cavalcanti; Márcia Maria Macêdo Lima; Nestor Piva

    2004-01-01

    A case of a pseudoneoplastic lesion of the breast clinically and sonographically suggestive of a fibroadenoma is reported. Excisional biopsy revealed the nodule was an inflammatory process consequent to infection by Schistosoma mansoni.Relata-se um caso de uma lesão pseudoneoplásica da mama clinicamente e ultrasonograficamente sugestiva de um fibroadenoma. A biópsia excisional revelou que o nódulo tratava-se de um processo inflamatório conseqüente à infecção pelo Schistosoma mansoni.

  20. Pseudoneoplastic lesion of the breast caused by Schistosoma mansoni Pseudoneoplasma da mama causado pelo Schistosoma mansoni

    Directory of Open Access Journals (Sweden)

    Carlos Anselmo Lima

    2004-02-01

    Full Text Available A case of a pseudoneoplastic lesion of the breast clinically and sonographically suggestive of a fibroadenoma is reported. Excisional biopsy revealed the nodule was an inflammatory process consequent to infection by Schistosoma mansoni.Relata-se um caso de uma lesão pseudoneoplásica da mama clinicamente e ultrasonograficamente sugestiva de um fibroadenoma. A biópsia excisional revelou que o nódulo tratava-se de um processo inflamatório conseqüente à infecção pelo Schistosoma mansoni.

  1. Qualidade percebida pelos clientes de um restaurante tradicional: estudo de caso: Casa das Enguias

    OpenAIRE

    Domingues, Rui Manuel Fonseca dos Santos

    2013-01-01

    A melhoria na qualidade do serviço ao cliente como uma estratégia de diferenciação das empresas cresce à medida que os produtos se tornam mais semelhantes e as empresas estabelecem assim, o seu fator de diferenciação a partir do valor que agregam à oferta. Como tal, para garantir a satisfação dos clientes, urge conhecer as suas necessidades. É neste enfoque que surge o presente estudo que tem como objetivos determinar a qualidade percebida pelos clientes de um restaurante de gastronomia tradi...

  2. TELETUBE: Novo passeio pelos bosques da ficção televisiva

    OpenAIRE

    Santana, Fernanda Castilho

    2014-01-01

    As narrativas de ficção, emitidas pelos canais de sinal aberto, figuram entre os programas televisivos de maior importância sociocultural, em virtude do inegável êxito conquistado entre os portugueses desde o final dos anos 70. Tendo como ponto de partida esse enquadramento histórico, notamos que a ficção televisiva perpassou diversas fases que acompanharam as alterações do panorama mediático nacional. No contexto atual, torna-se impossível ignorar o contributo da difusão ac...

  3. Reduction of empathy for pain by placebo analgesia suggests functional equivalence of empathy and first-hand emotion experience.

    Science.gov (United States)

    Rütgen, Markus; Seidel, Eva-Maria; Riečanský, Igor; Lamm, Claus

    2015-06-10

    Previous research in social neuroscience has consistently shown that empathy for pain recruits brain areas that are also activated during the first-hand experience of pain. This has been interpreted as evidence that empathy relies upon neural processes similar to those underpinning the first-hand experience of emotions. However, whether such overlapping neural activations imply that equivalent neural functions are engaged by empathy and direct emotion experiences remains to be demonstrated. We induced placebo analgesia, a phenomenon specifically modulating the first-hand experience of pain, to test whether this also reduces empathy for pain. Subjective and neural measures of pain and empathy for pain were collected using self-report and event-related potentials (ERPs) while participants underwent painful electrical stimulation or witnessed that another person was undergoing such stimulation. Self-report showed decreased empathy during placebo analgesia, and this was mirrored by reduced amplitudes of the pain-related P2, an ERP component indexing neural computations related to the affective-motivational component of pain. Moreover, these effects were specific for pain, as self-report and ERP measures of control conditions unrelated to pain were not affected by placebo analgesia. Together, the present results suggest that empathy seems to rely on neural processes that are (partially) functionally equivalent to those engaged by first-hand emotion experiences. Moreover, they imply that analgesics may have the unwanted side effect of reducing empathic resonance and concern for others.

  4. Perineural Dexamethasone to Improve Postoperative Analgesia with Peripheral Nerve Blocks: A Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Gildasio S. De Oliveira

    2014-01-01

    Full Text Available Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682 minutes, and motor block duration, 500 (154 to 846 minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, −8.5 (−12.3 to −4.6 mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.

  5. 5-Methoxy-N,N-dimethyltryptamine-induced analgesia is blocked by alpha-adrenoceptor antagonists in rats.

    Science.gov (United States)

    Archer, T; Danysz, W; Jonsson, G; Minor, B G; Post, C

    1986-10-01

    The effects of the alpha-adrenoceptor antagonists prazosin, phentolamine and yohimbine upon 5-methoxy-N,N-dimethyltryptamine (5-MeODMT)-induced analgesia were tested in the hot-plate, tail-flick and shock-titration tests of nociception with rats. Intrathecally injected yohimbine and phentolamine blocked or attenuated the analgesia produced by systemic administration of 5-MeODMT in all three nociceptive tests. Intrathecally administered prazosin attenuated the analgesic effects of 5-MeODMT in the hot-plate and tail-flick tests, but not in the shock titration test. Intrathecal yohimbine showed a dose-related lowering of pain thresholds in saline and 5-MeODMT-treated animals. Phentolamine and prazosin produced normal dose-related curves in the hot-plate test and biphasic effects in the shock titration and tail-flick tests. These results demonstrate a functional interaction between alpha 2-adrenoceptors and 5-HT agonist-induced analgesia at a spinal level in rats. PMID:2877697

  6. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Directory of Open Access Journals (Sweden)

    Anis Dizdarevic

    2016-01-01

    Full Text Available Objective. Primary lateral sclerosis (PLS is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS. Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use.

  7. The Effects of Thoracic Epidural Analgesia on Postoperative Pain and Myocardial Protection in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Bestami Barış Çelik

    2015-03-01

    Full Text Available Aim: Thoracic epidural analgesia (TEA in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG on postoperative pain, myocardial protection, intensive care unit (ICU and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20 and control group (n=20. Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p<0.01. There was no difference in length of stay in the ICU, CK-MB and troponin I levels between the groups, however, length of hospital stay was shorter in TEA group. Conclusion: TEA with levobupivakain in CABG was found to provide stable hemodynamics, effective analgesia and to shorten length of hospital stay. (The Medical Bulletin of Haseki 2015; 53: 72-6

  8. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Science.gov (United States)

    Fernandes, Anthony

    2016-01-01

    Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use. PMID:27200193

  9. Neuropeptide FF and related peptides attenuates warm-, but not cold-water swim stress-induced analgesia in mice.

    Science.gov (United States)

    Li, Ning; Han, Zheng-lan; Fang, Quan; Wang, Zi-long; Tang, Hong-zhu; Ren, Hui; Wang, Rui

    2012-08-01

    Neuropeptide FF (NPFF) belongs to a neuropeptide family including two receptors (NPFF(1) and NPFF(2)). NPFF system has been reported to play important roles in pain transmission. The aim of the present study was to investigate the roles of NPFF related peptides and their receptors in swim stress-induced analgesia (SIA). Nociceptive test was performed in mice stressed by forced swimming in water at 15 °C (cold water swimming) or 32 °C (warm water swimming). Warm water swimming produced a naloxone-mediated antinociceptive effect. This warm water swim SIA was dose-dependently antagonized by i.c.v. injection of NPFF and two related peptides (3-30 nmol), NPVF and dNPA, which exhibited the highest selectivities for NPFF(1) and NPFF(2) receptors, respectively. Moreover, the selective NPFF receptor antagonist RF9 (30 nmol) was inactive by itself, but prevented the effects of NPFF and related peptides. Cold-water swimming produced a wilder analgesic effect that was blocked by MK-801, but not naloxone. However, NPFF system failed to modify the cold water swim stress-induced analgesia. These findings demonstrated that NPFF and related peptides attenuated opioid-mediated form of SIA via NPFF receptors in the brain, but not non-opioid swim stress-induced analgesia. These data further support an anti-opioid character of NPFF system.

  10. Effect of Transcutaneous Electrical Acupoint Stimulation on Nausea and Vomiting Induced by Patient Controlled Intravenous Analgesia with Tramadol

    Institute of Scientific and Technical Information of China (English)

    ZHENG Li-hong; SUN Hong; WANG Guo-nian; LIANG Jie; WU Hua-xing

    2008-01-01

    Objective" To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on nausea and vomiting (N&V) induced by patient controlled intravenous analgesia (PCIA) with Tramadol. Methods= Sixty patients who were ready to receive scheduled operation for tumor in the head-neck region and post-operation PCIA, aged 39-65 years, with the physique grades Ⅰ-Ⅱ of ASA, were randomized into two groups, A and B, 30 in each group. The pre-operation medication, induction of analgesia and continuous anesthesia used in the two groups were the same. TEAS on bilateral Hegu (LI4) and Neiguan (PC6) points was intermittently applied to the patients in group A starting from 30 min before analgesia induction to 24 h after operation, and the incidence and score of nausea and vomiting, antiemetic used, visual analogue scores (VAS), and PCIA pressing times in 4 time segments (0-4, 4-8, 8-12 and 12-24 h after the operation was finished) were determined. The same management was applied to patients in Group B, with sham TEAS for control. Results: The incidence and degree of N&V, as well as the number of patients who needed remedial antiemetic in Group A were less than those in Group B. The VAS score and PCIA pressing time were lower in Group A than those in Group B in the corresponding time segments respectively. Conclusion: TEAS could prevent N&V induced by PCIA with Tramadol.

  11. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

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    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  12. Topically applied mesoridazine exhibits the strongest cutaneous analgesia and minimized skin disruption among tricyclic antidepressants: The skin absorption assessment.

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    Liu, Kuo-Sheng; Chen, Yu-Wen; Aljuffali, Ibrahim A; Chang, Chia-Wen; Wang, Jhi-Joung; Fang, Jia-You

    2016-08-01

    Tricyclic antidepressants (TCAs) are found to have an analgesic action for relieving cutaneous pain associated with neuropathies. The aim of this study was to assess cutaneous absorption and analgesia of topically applied TCAs. Percutaneous delivery was investigated using nude mouse and pig skin models at both infinite and saturated doses. We evaluated the cutaneous analgesia in nude mice using the pinprick scores. Among five antidepressants tested in the in vitro experiment, mesoridazine, promazine and doxepin showed a superior total absorption percentage. The drug with the lowest total absorption percentage was found to be fluphenazine (dose or at saturated solubility. The follicular pathway was important for mesoridazine and promazine delivery. Mesoridazine showed stronger skin analgesia than the other TCAs although the in vivo skin absorption of mesoridazine (0.34nmol/mg) was less than that of promazine (0.80nmol/mg) and doxepin (0.74nmol/mg). Mesoridazine had a prolonged duration of pain relief (165min) compared to promazine (83min) and doxepin (17min). The skin irritation test demonstrated an evident barrier function deterioration and cutaneous erythema by promazine and doxepin treatment, whereas mesoridazine caused no obvious adverse effect by topical application for up to 7days. PMID:27260201

  13. Padrão de ocorrência de doenças em mamão armazenado sob atmosfera controlada Evolution of postharves diseases on papaya storaged under controlled atmosphere

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    Marcos José de Oliveira Fonseca

    2004-12-01

    Full Text Available O objetivo deste trabalho foi avaliar a dinâmica de evolução de doenças pós-colheita do mamão armazenado sob atmosfera controlada, contendo 3,0% de O2 e 6,0% de CO2 ou 3,0% de O2 e 3,0% de CO2, em relação aos armazenados sob atmosfera ambiente, na simulação de condições de exportação refrigerada (10ºC via marítima, e de comercialização no mercado europeu dos mamões 'Sunrise Solo' e 'Golden'. Constatou-se que a atmosfera controlada contendo 3% de O2 e 6% de CO2 promoveu maior perda de frutos, descartados devido à ocorrência das principais doenças pós-colheita: Antracnose, Podridão Peduncular, Mancha Chocolate e, principalmente, Pinta Preta, em ambas as cultivares. Acredita-se que a elevação da concentração de CO2 tenha provocado injúria fisiológica e que isto tenha favorecido a infecção dos tecidos e sua colonização.The goal of this study was to evaluate the evolution of postharvest diseases on papaya storaged under controlled atmosphere, with 3,0% of O2 and 3,0 % or 6,0% of CO2, in relation to environment atmosphere (21,0% of O2 e 0,00365% of CO2, in simulation of refrigerated (10ºC maritime transport and commercialization in European market, of 'Sunrise Solo' and 'Golden' papayas. The controlled atmosphere containg 3% of O2 and 6% of CO2, promoted more fruit losses due the increase of postharvest diseases: anthracnosis, chocolat spot, stem-end-rot and, mainly, black spot, on both cultivars. Probably, the increase of of CO2 concentration, promoted injury in superficial cells, infection and tissue colonization.

  14. Effects of flurbiprofen on the analgesia and requirment of morphine during postoperative analgesia%术后镇痛中氟比洛芬酯对吗啡用量及效果的影响

    Institute of Scientific and Technical Information of China (English)

    吴卫东; 姜春南; 邵钢; 尹丹琴; 韦宁仙

    2011-01-01

    目的 评价术后镇痛中氟比洛芬酯对吗啡用量和效果的影响.方法 手术患者60例,随机均分为三组.术后镇痛:A组,吗啡40 mg+阿扎司琼10 mg+生理盐水100 ml;B组用氟比洛芬酯50 mg超前镇痛,术后吗啡40 mg+阿扎司琼10 mg+生理盐水100 ml;C组氟比洛芬酯100 mg+阿扎司琼10 mg+吗啡40 mg+生理盐水100 ml.观察术后吗啡的用量,患者自控镇痛(PCA)总次数,术后4、8、12、24 h的VAS疼痛评分.结果 与A组比较,B、C组术后12、24 h吗啡用量减少,PCA总次数减少,VAS评分降低(P<0.05).结论 氟比洛芬酯50 mg超前镇痛或镇痛泵中氟比洛芬酯100 mg与吗啡配伍,具有较好的镇痛效果,可减少吗啡用量.%Objective To evaluate the effects of flurbiprofen on the analgesia and requirement of morphine during patient-controlled intravenous analgesia(PCIA). Methods PCIA was performed in 60 patients underwent surgeries, who were randomly and equally divided into 3 groups of A(morphine 40 mgm+ azasetron 10 mg + normal saline 100 ml), B(50 mg flurbiprofen preemptive analgesia and postoperative morphine 40 mg+azasetron 10 mg+normal saline 100 ml), and C(flurhiprofen 100 mg+azasetron 10 mg+morphine 40 mg+normal saline 100 ml). The morphine consumption, PCA number and VAS scores at 4,8, 12, 24 h during PCIA were recorded. Results Compared to group A, the morphine consumption and PCA number were less,and VAS scores were lower in groups of B and C (P<0. 05). Conclusion Preemptive analgesia with flurbiprofen 50 mg or flurbiprofen 100 mg added to PCIA solution with morphine has a satisfactory analgesia and reduced requirements of morphine during postoperative pain relief.

  15. Stress-induced visceral analgesia assessed non-invasively in rats is enhanced by prebiotic diet

    Institute of Scientific and Technical Information of China (English)

    Muriel Larauche; Agata Mulak; Pu-Qing Yuan; Osamu Kanauchi; Yvette Taché

    2012-01-01

    AIM: To investigate the influence of repeated water avoidance stress (rWAS) on the visceromotor response (VMR) to colorectal distension (CRD) and the modulation of the response by a prebiotic diet in rats using a novel surgery-free method of solid-state manometry.METHODS: Male Wistar rats fed a standard diet with or without 4% enzyme-treated rice fiber (ERF) for 5 wk were subjected to rWAS (1 h daily x 10 d) or no stress. The VMR to graded phasic CRD was assessed by intraluminal colonic pressure recording on days 0 (baseline), 1 and 10 (45 min) and 11 (24 h) after rWAS and expressed as percentage change from baseline. Cecal content of short chain fatty acids and distal colonic histology were assessed on day 11.RESULTS: WAS on day 1 reduced the VMR to CRD at 40 and 60 mmHg similarly by 28.9% ± 6.6% in both diet groups. On day 10, rWAS-induced reduction of VMR occurred only at 40 mmHg in the standard diet group (36.2% ± 17.8%) while in the ERF group VMR was lowered at 20, 40 and 60 mmHg by 64.9% ± 20.9%, 49.3% ± 11.6% and 38.9% ± 7.3% respectively. The visceral analgesia was still observed on day 11 in ERF- but not in standard diet-fed rats. By contrast the non-stressed groups (standard or ERF diet) exhibited no changes in VMR to CRD. In standard diet-fed rats, rWAS induced mild colonic histological changes that were absent in ERF-fed rats exposed to stress compared to non-stressed rats. The reduction of cecal content of isobutyrate and total butyrate, but not butyrate alone, was correlated with lower visceral pain response. Additionally, ERF diet increased rWAS-induced defecation by 26% and 75% during the first 0-15 min and last 15-60 min, respectively, compared to standard diet, and reduced rats' body weight gain by 1.3 fold independently of their stress status. CONCLUSION: These data provide the first evidence of psychological stress-related visceral analgesia in rats that was enhanced by chronic intake of ERF prebiotic.

  16. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

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    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüências deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO: Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náuseas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS: Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES: Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor. Estudos clínicos com maior número de casos s

  17. The effect of postoperative analgesia of flurbiprofen for percutaneous vertebral angioplasty in preemptive analgesia%氟比洛酚酯超前镇痛用于经皮椎体成形术术后镇痛的效果

    Institute of Scientific and Technical Information of China (English)

    崔鸿飞

    2011-01-01

    目的 观察氟比洛酚酯超前镇痛对经皮椎体成形术术后镇痛效果的影响.方法 选择ASAⅠ-Ⅱ级择期行经皮椎体成形术切除术患者40例,随机均分为氟比洛酚酯超前镇痛组和氟比洛酚酯术后镇痛组.超前镇痛组于手术前静注氟比洛酚酯50 mg;术后镇痛组于手术结束时静注氟比洛酚酯50 mg.用视觉模拟评分(VAS)评定术后0、1、4、8和12 h的疼痛程度及术后24 h总体镇痛评价.记录患者追加镇痛药和出现不良反应的情况.结果 术后24 h总体VAS评分B组为(1.8±0.6)分,与超前镇痛组的(3.2±0.8)差异有统计学意义(P<0.05).两组均未见明显不良反应.结论 氟比洛酚酯超前镇痛应用于经皮椎体成形术术后镇痛效果确切、使用方便、不良反应小.%Objective To observe the effect of postoperative analgesia of flurbiprofen for percutaneous vertebral angioplasty in preemptive analgesia. Methods 40 paifients with ASA Ⅰ - Ⅱ level elective through skin vertebral angioplasty resection patients were seleted and randomly divided into 40 cases, flurbiprofen preemptive analgesia group(group A), and flurbiprofen postoperative analgesia group (group B). Group A was administrated with 50mg flurbiprofen before operation through intravenous, and Group B was administrated with it in the end of operation. By visual analog scale(VAS) ,the score of postoperative 0,1,4,8 and 12h level of pain and postoperative analgesia 24h overall evaluation was assessed. And the additional analgesics and deelop aderse reactions of patients were recorded.Results After operation 24h overall VAS score of group B (1.8 + 0.6) points was above that of group A (3.2 +0. 8) points (P < 0.05). Both groups had no obvious adverse reactions. Conclusion Postoperative analgesia of flurbiprofen for pereutaneous vertebral angioplasty in preemptive analgesia had exact effect,convenience and less adverse reactions.

  18. A criança: interlocutor do conhecimento mediado pelo professor

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    Alexandre Freitas Marchiori

    2010-10-01

    Full Text Available http://dx.doi.org/10.5007/1980-4512.2010n22p58 A proposta de trabalho corresponde apresentar as práticas de ensino desenvolvidas no CMEI Denizart Santos, nesse primeiro semestre de 2010, tendo a criança como protagonista na produção do conhecimento e o professor como mediador desse processo. Abordar-se-á o projeto “Tarsila do Amaral” desenvolvido pelos professores dinamizadores de Arte e Educação Física, todavia sob a perspectiva de visualizar a apropriação da produção cultural e os possíveis significados dados pelos sujeitos infantes. A perspectiva defendida neste trabalho só é possível se a criança for reconhecida como ator social, sujeito produtor de cultura, constituído e constituinte da sociedade, que possui capacidades plenas para dar sentido às suas experiências e (ressignificá-las.

  19. Conhecendo as estrategias de acao e interacao utilizadas pelos clientes para o enfrentamento da dialise peritoneal

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    Felipe Kaezer dos Santos

    2013-09-01

    Full Text Available Este artigo teve por objetivo apresentar as principais estratégias de ação e interação utilizadas pelos clientes portadores de doença renal crônica para o enfrentamento da diálise peritoneal. O referencial teórico utilizado foi o Interacionismo Simbólico, por ser um arcabouço que valoriza o significado da interação como determinante do comportamento humano. A Teoria Fundamentada nos Dados foi utilizada como referencial metodológico. Após a sua obtenção, realizada por meio de um roteiro de entrevista semi-estruturado, os dados foram gravados, transcritos, codificados e organizados para compor a teoria explicativa sobre o fenômeno estudado. Durante a análise foram identificados vários recursos utilizados pelos clientes, como a necessidade de obter informações sobre a diálise peritoneal, o refúgio na espiritualidade e a falsa ilusão da cura. Destaca-se também a importância da rede de apoio, em que o enfermeiro poderá atuar como facilitador do processo de enfrentamento, em prol da adaptação dos clientes à nova realidade.

  20. Relação entre a infusão contínua de dexmedetomidina e a fração expirada de sevoflurano monitorizada pelo índice bispectral

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    Magalhães Edno

    2004-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação de agentes venosos à anestesia geral inalatória proporciona melhor qualidade de analgesia e hipnose. A dexmedetomidina é um agonista específico alfa2-adrenérgico com estas características e reconhecida por proporcionar estabilidade hemodinâmica. O objetivo do estudo foi avaliar o efeito da infusão contínua de dexmedetomidina na fração expirada de sevoflurano (FEsevo em anestesia geral, monitorizada pela análise bispectral do EEG (BIS. MÉTODO: Estudou-se, de modo prospectivo, 24 pacientes adultos, de ambos os sexos, estado físico ASA I e II, submetidos à cirurgias eletivas sob anestesia geral, monitorizados com ECG, PANI, SpO2, P ET CO2, FEsevo e BIS. Procedeu-se a indução venosa com alfentanil (30 µg.kg-1, tiopental (5 mg.kg-1 e vecurônio (0,1 mg.kg-1 e intubação traqueal. Iniciaram-se a administração de sevoflurano (manutenção do BIS entre 40 e 60, a ventilação controlada com volume corrente de 10 ml.kg-1 e a manutenção da P ET CO2 entre 35 e 45 mmHg. Na fase de manutenção da anestesia, após 60 minutos da indução anestésica (M60, foi iniciada a infusão contínua de dexmedetomidina em 2 fases: infusão inicial (1 µg.kg-1 em 20 minutos; e, infusão de manutenção (0,5 µg.kg-1.h-1. A concentração de sevoflurano foi ajustada para manter o valor de BIS entre 40 e 60. As variáveis de PA, FC, FEsevo, SpO2, P ET CO2 e BIS foram avaliadas nos momentos pré-indução (M-15, M15, M45, M75, M105 e M120. RESULTADOS: A associação da dexmedetomidina à anestesia geral com sevoflurano proporcionou redução significativa (p < 0,05 da FEsevo de M45 (1,604 ± 0,485 a M105 (1,073 ± 0,457 e de M45 (1,604 ± 0,485 a M120 (1,159 ± 0,475. As variáveis hemodinâmicas analisadas apresentaram diferenças estatisticamente significantes com p < 0,05, mas sem repercussões clínicas. CONCLUSÕES: A associação de dexmedetomidina em infusão contínua (0,5 µg.kg-1.h-1 à anestesia

  1. Use of transcutaneous electrical nerve stimulation as an adjunctive to epidural analgesia in the management of acute thoracotomy pain

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    Alka Chandra

    2010-01-01

    Full Text Available The present randomized study was conducted in our institute of pulmonary medicine and tuberculosis over a period of 1 year. This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS as an adjunctive to thoracic epidural analgesia for the treatment of postoperative pain in patients who underwent posterolateral thoracotomy for decortication of lung. Sixty patients in the age group 15-40 years scheduled to undergo elective posterolateral thoracotomy were divided into two groups of 30 each. Patients were alternatively assigned to one of the groups. In group I, only thoracic epidural analgesia with local anaesthetics was given at regular intervals; however, an identical apparatus which did not deliver an electric current was applied to the control (i.e. group I patients. While in group II, TENS was started immediately in the recovery period in addition to the epidural analgesia. A 0-10 visual analog scale (VAS was used to assess pain at regular intervals. The haemodynamics were also studied at regular intervals of 2 h for the first 10 h after the surgery. When the VAS score was more than three, intramuscular analgesia with diclofenac sodium was given. The VAS score and the systolic blood pressure were comparable in the immediate postoperative period (P = NS but the VAS score was significantly less in group II at 2, 4, 6, 8 h (P < 0.01, P < 0.05, P < 0.05, P < 0.05, respectively, and at 10 h the P value was not significant. Similarly, the systolic blood pressure was significantly less in group II at 2, 4, 6 h after surgery, that is P < 0.02, P < 0.01, P < 0.01, respectively, but at 8 and 10 h the pressures were comparable in both the groups. Adding TENS to epidural analgesia led to a significant reduction in pain with no sequelae. The haemodynamics were significantly stable in group II compared to group I. TENS is a valuable strategy to alleviate postoperative pain following thoracic surgery with no side

  2. Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

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    Licia Santos Santana

    2016-01-01

    Full Text Available Questions: In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Design: Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Participants: Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4 cm, and without the use of any medications from hospital admission until randomisation. Intervention: The principal investigator applied TENS to the experimental group for 30 minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. Outcome measures: The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. Results: After the intervention, a significant mean difference in change in pain of 15 mm was observed favouring the experimental group (95% CI 2 to 27. The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0 hours (95% CI 4.1 to 5.9 longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. Conclusion: TENS produces a significant decrease in pain during labour and postpones the need for pharmacological

  3. μ-Opioid and N-methyl-D-aspartate receptors in the amygdala contribute to minocycline-induced potentiation of morphine analgesia in rats.

    Science.gov (United States)

    Ghazvini, Hamed; Rezayof, Ameneh; Ghasemzadeh, Zahra; Zarrindast, Mohammad-Reza

    2015-06-01

    The aim of the present study was to investigate the role of the amygdala in the potentiative effect of minocycline, a semisynthetic tetracycline antibiotic, on morphine analgesia in male Wistar rats. We also examined the involvement of the amygdala μ-opioid and N-methyl-D-aspartate (NMDA) receptors in the minocycline-induced potentiation of morphine analgesia. Intraperitoneal administration of morphine (3-9 mg/kg) induced analgesia in a tail-flick test. Bilateral intra-amygdala injection of minocycline (10-20 μg/rat) enhanced the analgesic response of an ineffective dose of morphine (3 mg/kg). Injection of a higher dose of minocycline into the amygdala also induced analgesia. Moreover, bilateral intra-amygdala injection of naloxone (0.5-1.5 µg/rat) reversed minocycline-induced potentiation of morphine analgesia. Pretreatment of animals with NMDA (0.01-0.1 μg/rat, intra-amygdala) also inhibited the potentiative effect of minocycline on morphine response. Bilateral intra-amygdala injection of the same doses of naloxone or NMDA plus morphine had no effect on the tail-flick latency in the absence of minocycline. It can be concluded that the amygdala has a key role in the potentiative effect of minocycline on morphine analgesia. In addition, amygdala opioidergic and glutamatergic mechanisms may be involved, probably through μ-opioid and NMDA receptors, in the modulation of the minocycline-induced potentiation of morphine analgesia in the tail-flick test. PMID:25563202

  4. ROPIVACAINE CONTINUOUS WOUND INFUSION VERSUS CONTINUOUS EPIDURAL VERSUS SYSTEMIC ANALGESIA FOR POST CAESAREAN DELIVERY UNDER SPINAL ANAESTHESIA: A PROSPECTIVE RANDOMISED CONTROLLED STUDY

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    Paleti

    2014-07-01

    Full Text Available BACKGROUND: Opioid based analgesic regimens have been the gold standard for post caesarean analgesia until recently. Regional techniques like local intra-wound infusion techniques are becoming popular now. Our aim is to evaluate the efficacy of 0.2% Ropivacaine continuous wound infusion versus continuous epidural versus conventional systemic analgesia for post caesarean delivery. METHODOLOGY: 60 healthy parturients of ASA I/II were randomized after elective caesarean section into 3 groups of 20 each. Group-A: Received 0.2% Ropivacaine via an epidural catheter placed into subcutaneous tissue and fascia before skin closure at the rate of 5ml/hr. through infusion pump. Group-B: Received 0.2% Ropivacaine continuous epidural infusion via an epidural catheter at the rate of 8ml/hr. An initial bolus of 10ml was given in groups A&B. Group-C: Received standard systemic analgesia with diclofenac sodium and rescue opioid. Post operatively parturients were assessed for VAS scores for pain at rest and during movement, total Ropivacaine consumption, Tramadol consumption and side effects. Data were analyzed using SPSS software version 22. RESULTS: There were no significant differences in the mean VAS scores at rest and at movement between groups A or B and C. The consumption of Tramadol was significantly greater in Group C (p value AC=0.025, BC=0.0000 than A or B. Mean Ropivacaine consumption is significantly higher in Group B (p=0.000 than Group A. CONCLUSION: Continuous local intra-wound analgesia with Ropivacaine produced comparable analgesia to that of continuous epidural and superior analgesia compared to standard systemic analgesia.

  5. Analgesia e sedacao durante a instalacao do cateter central de insercao periferica em neonatos

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    Priscila Costa

    2013-08-01

    Full Text Available Objetivou-se caracterizar as estratégias de analgesia e sedação em neonatos submetidos à instalação do cateter central de inserção periférica (CCIP e relacioná-las ao número de punções venosas, duração do procedimento e posicionamento da ponta do cateter. Estudo transversal com coleta prospectiva de dados, realizado em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de São Paulo, no período de 31 de agosto de 2010 a 01 de julho de 2011, em que foram avaliadas 254 inserções do CCIP. A adoção de estratégias analgésicas ou sedativas ocorreu em 88 (34,6% instalações do cateter e não esteve relacionada ao número de punções venosas, duração do procedimento ou posicionamento da ponta do cateter. As estratégias mais frequentes foram a administração endovenosa de midazolam em 47 (18,5% e fentanil em 19 (7,3% inserções do cateter. Recomenda-se maior adoção de estratégias analgésicas antes, durante e após o procedimento.

  6. A COMPARISON OF KETOROLAC, DICLOFENAC AND PARACETAMOL FOR POSTOPERATIVE ANALGESIA FOLLOWING ABDOMINAL HYSTERECTOMY

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    Gaurav

    2015-11-01

    Full Text Available BACKGROUND Abdominal hysterectomy is associated with moderate-to-severe postoperative pain. Among non-opioid analgesics diclofenac, paracetamol and ketorolac are most commonly used. OBJECTIVES: The aim of this study was to compare the analgesic duration, efficacy and side effect profile of paracetamol, diclofenac and ketorolac administered intravenously in patients who underwent abdominal hysterectomy. METHODS In a prospective double-blinded study, in which 90 women undergoing elective abdominal hysterectomy under spinal anesthesia were randomly selected and divided into 3 groups to receive 1ml (75mg Diclofenac (Group D, 1ml (30mg Ketorolac (Group K and 100ml (1000mg Paracetamol (Group P. Two hours post spinal anesthesia, irrespective of completion of surgery study drug was administered intravenously. In post-operative ward analgesic, efficacy was assessed hourly using a visual analog scale (VAS, duration of motor blockade due to spinal anesthesia (Modified Bromage scale, time for rescue analgesia (VAS>4 were compared and occurrence of adverse effects noted. STATICS Collected data was analyzed using ANOVA. RESULTS The time taken to administer the first dose of rescue analgesic was significantly (P <0.05 delayed in the group K (276mins. Overall, mean postoperative VAS scores were significantly better with (Group K and VAS scores were not significantly different between other (Group P and (Group D. CONCLUSION Ketorolac was a better post-operative analgesic compared to diclofenac and paracetamol.

  7. Onset of Analgesia and Efficacy of Ibuprofen Sodium in Postsurgical Dental Pain

    Science.gov (United States)

    Brain, Patrick; Leyva, Rina; Doyle, Geraldine

    2015-01-01

    Objectives: A novel, immediate-release tablet formulation of ibuprofen (IBU) sodium dihydrate, Advil Film Coated Tablets (IBUNa), has been developed that is absorbed faster than standard IBU tablets. The objective of the current study was to compare the efficacy and onset of analgesia of this new formulation with standard IBU tablets after a single dose. Materials and Methods: Patients (N=316) with at least moderate baseline postsurgical dental pain were randomized to 400 mg IBUNa, Advil (IBUAdv), Motrin (IBUMot), or placebo. Primary endpoints were time-weighted sum of pain relief (PR) and pain intensity differences over 8 hours (SPRID 0-8) and time to onset of meaningful pain relief (TMPR) measured by the double-stopwatch method. Results: SPRID 0-8 was significantly greater for IBUNa and the other active treatments versus placebo (P<0.001). IBUNa had a significantly earlier TMPR versus placebo, pooled IBUAdv/IBUMot, and IBUMot (P<0.001 for all), and a marginally faster TMPR (P=0.075) versus IBUAdv. Results for secondary endpoints were similar. Adverse events were comparable across treatment groups, with gastrointestinal disorders being most frequently reported. Most adverse events were mild or moderate. Discussion: This novel formulation of IBUNa provided superior overall PR compared with placebo and more rapid onset of analgesic effect compared with standard IBU tablets. Rapid PR is important in the treatment of acute pain, including dental pain, and this IBUNa formulation represents a new treatment option for rapid PR. PMID:25119511

  8. Book review. Anestesia e analgesia locoregionale del cane e del gatto. Francesco Staffieri

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    Manuel Graziani

    2014-03-01

    Full Text Available Il volume di anestesia e analgesia locoregionale del cane e del gatto è pensato per essere un testo "da sala operatoria" – come afferma l'autore – perché consente un rapido, ma allo stesso tempo dettagliato, consulto per il libero professionista che si trova a gestire un'anestesia. Si tratta di un piccolo libro, tascabile, che può essere considerato un punto di partenza per gli studenti e per tutti quei medici veterinari che intendono avvicinarsi in maniera specialistica all'arte dell'anestesiologia veterinaria. L'anestesia locoregionale costituisce, infatti, uno strumento insostituibile per la gestione del dolore perioperatorio in medicina veterinaria. Nel volume si forniscono le nozioni di base per praticare i principali blocchi nervosi centrali e periferici. Per ogni blocco sono riportate le tecniche alla cieca (mediante l'ausilio dei punti di repere anatomici e quelle con l'impiego dello stimolatore nervoso periferico. Il volume, corredato da immagini foto e grafici, per un totale di 65 figure, si apre con i capitoli relativi ai farmaci, agli strumenti e alle complicanze dell'anestesia locoregionale. Prosegue con i blocchi nervosi centrali (anestesia epidurale e spinale e si conclude con i blocchi periferici (testa, arto anteriore, torace, arto posteriore. L'autore, Francesco Staffieri, è un medico veterinario che svolge il dottorato di ricerca nel Dipartimento delle Emergenze e dei Trapianti di Organi, Sezioni di Cliniche Veterinarie e Produzioni Animali dell'Università degli Studi Aldo Moro di Bari.

  9. Increased sensitivity to cocaine-induced analgesia in Spontaneously Hypertensive Rats (SHR

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    Takahashi Reinaldo N

    2007-02-01

    Full Text Available Abstract This study examined the analgesic effect of cocaine in Spontaneously Hypertensive Rats (SHR, which are considered a suitable model for the study of attention deficit hyperactivity disorder (ADHD, and in Wistar (WIS rats of both sexes using the hot-plate test. In addition, we tested whether habituation to the unheated hot-plate apparatus, that "normalizes" the basal hypoalgesic phenotype of SHR, alters the subsequent cocaine-induced analgesia (CIA in this strain. SHR of both sexes were hypoalgesic compared to WIS rats in the hot-plate test and showed higher sensitivity to CIA. Habituation to the unheated hot-plate reduced the basal nociceptive latency of SHR, suggesting cognitive/emotional modulation of pain in this strain, but did not alter the magnitude of CIA. The present study shows increased sensitivity to CIA in SHR, which may be related to abnormalities in the mesocorticolimbic dopaminergic system. Further studies using SHR strain may reveal new information on the neurobiological mechanisms underlying ADHD and its co-morbidity with drug addiction.

  10. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  11. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol

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    Meena Doda

    2009-01-01

    Full Text Available Thirty children, ASAI-II, aged between 2yrs-5yrs, undergoing sub umbilical operation (inguinal and penile surgery were selected for this double blind study. They were randomly divided in two groups, group Aand group B. Group A(n15 received 0.25%bupivacaine 0.5ml.kg -1 and Group B (n=15 received 0.25% bupivaeaine 0.5ml.kg -1 and tramadol 2mg.kg -1 as single shot caudal block. Postoperative pain was assessed by a modified TPPPS (Toddler-Preschool Postoperative Pain Scale and analgesic given only when the score was more than 3. In the first 24 hrs it was observed that the mean duration of time interval between the caudal block and first dose of analgesic was significantly long(9. lhrs in Group B as compared to Group A (6.3hrs which was much shorter(p< 0.01.There was no significant haemodynamie changes, motor weakness or respiratory depression in both groups. This study con-cluded that addition of tramadol 2mg.kg -1 to caudal 0.25% bupivacaine 0.5ml.kg -1 significantly prolong the duration of postoperative analgesia in children withoutprodueing much adverse effects.

  12. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

    Science.gov (United States)

    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-01-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods. PMID:27247165

  13. Sucrose-induced analgesia in mice: Role of nitric oxide and opioid receptor-mediated system

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    Abtin Shahlaee

    2013-01-01

    Full Text Available Background: The mechanism of action of sweet substance-induced analgesia is thought to involve activation of the endogenous opioid system. The nitric oxide (NO pathway has a pivotal role in pain modulation of analgesic compounds such as opioids. Objectives: We investigated the role of NO and the opioid receptor-mediated system in the analgesic effect of sucrose ingestion in mice. Materials and Methods: We evaluated the effect of intraperitoneal administration of 10 mg/kg of NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME and 20 mg/kg of opioid receptor antagonist, naltrexone on the tail flick response in sucrose ingesting mice. Results: Sucrose ingestion for 12 days induced a statistically significant increase in the latency of tail flick response which was unmodified by L-NAME, but partially inhibited by naltrexone administration. Conclusions: Sucrose-induced nociception may be explained by facilitating the release of endogenous opioid peptides. Contrary to some previously studied pain models, the NO/cyclic guanosine monophosphate (cGMP pathway had no role in thermal hyperalgesia in our study. We recommend further studies on the involvement of NO in other animals and pain models.

  14. Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia Clonidina y dexmedetomidina por vía peridural para analgesia y sedación pós-operatoria de colecistectomía Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation

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    Antônio Mauro Vieira

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A clonidina e a dexmedetomidina são agonistas alfa2-adrenérgicos que, quando administrados por via peridural, possuem propriedades analgésicas e potencializam os efeitos dos anestésicos locais. A presente pesquisa objetivou avaliar a analgesia e a sedação produzidas pela clonidina ou dexmedetomidina associadas à ropivacaína, por via peridural, no pós-operatório de colecistectomia por via subcostal. MÉTODO: Participaram do estudo aleatório e duplamente encoberto 40 pacientes, de ambos os sexos, com idade variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia por via subcostal, os quais foram distribuídos em dois grupos: clonidina (GC, em que foi administrada clonidina (1 ml = 150 µg associada à ropivacaína a 0,75% (20 ml por via peridural; dexmedetomidina (GD, em que foi injetada dexmedetomidina (2 µg.kg-1 associada à ropivacaína a 0,75% (20 ml por via peridural. A analgesia e a sedação foram observadas 2, 6 e 24 horas após o término da anestesia. RESULTADOS: Ocorreu sedação depois de 2 e 6 horas em ambos os grupos, sendo que houve diferença estatística significante entre os tempos de 2 e 6 horas no grupo dexmedetomidina. Houve analgesia em ambos os grupos, especialmente depois de 2 e 6 horas. Foi detectada diferença estatística significante entre os tempos de 2, 6 e 24 horas no grupo dexmedetomidina; no grupo clonidina essa diferença estatística significante foi observada entre os tempos de 2 e 6 horas e entre 2 e 24 horas. CONCLUSÕES: Os resultados permitiram concluir que a clonidina ou a dexmedetomidina associadas à ropivacaína a 0,75% asseguraram analgesia e sedação nos tempos de observação de 2 e 6 horas após o término da anestesia, nos pacientes submetidos à colecistectomia por via subcostal e que a clonidina promove analgesia mais prolongada.JUSTIFICATIVA Y OBJETIVOS: La clonidina y la dexmedetomidina son agonistas alfa2

  15. Bioavailability of immediate and controlled release formulations of lithium carbonate Biodisponibilidade de formulações de liberação imediata e controlada de carbonato de lítio

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    Luciana Vismari

    2002-06-01

    Full Text Available INTRODUCTION/OBJECTIVES: Controlled-release lithium formulations were developed to minimize elevated blood peaks, related to side-effects and intoxications. However, there is little information about the bioavailability of the only controlled-release lithium formulation available in Brazil. The objective of this study was to compare the bioavailability of controlled-release and immediate-release lithium formulations, after single and multiple doses. METHODS: Twelve healthy volunteers received 900 mg of immediate-release or controlled-release lithium carbonate in single or multiple doses during 9 days. After single dose administration, the following parameters were analyzed for each formulation: maximum lithium concentration (Cmax; time to reach Cmax (t max; area under the curve of serum concentration versus time (AUC0-12 and AUC0-¥ and the elimination half-life (t1/2 elim.. After multiple doses, Cmax; t max; AUC0-12; mean (Cmean and minimum drug concentration (Cmin and degree of fluctuation (DF were analyzed. A 90% confidence interval (90%CI for the ratio between the AUCs for each formulation was constructed. RESULTS/DISCUSSION: Following single dose, the two formulations were bioequivalent; however, they were not after multiple doses. This fact could be a consequence of methodological limitations of lithium level's measurements since, following single dose, these levels could not be detected at time periods 24 and 48h in many volunteers, compromising the calculation of t1/2 elim ,and consequently of the AUC0-¥ and the 90%CI to the ratio of these areas. Therefore, the bioequivalence found after single dose may be an unreliable result.INTRODUÇÃO/OBJETIVO: Formulações de liberação controlada de lítio foram produzidas para minimizar picos sangüíneos elevados relacionados a efeitos colaterais e intoxicações. No entanto, o único produto com liberação controlada de lítio disponível no Brasil possui poucas informações a respeito de

  16. Plataformas bio(muco adesivas poliméricas baseadas em nanotecnologia para liberação controlada de fármacos - propriedades, metodologias e aplicações

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    Flávia Chiva Carvalho

    2014-01-01

    Full Text Available Nos últimos tempos, grande destaque tem sido dado no estudo de sistemas bio(mucoadesivos de liberação de fármacos, os quais podem promover um direcionamento e uma retenção mais específica do fármaco incorporado no sistema de liberação, empregando as mais variadas membranas de absorção do organismo. Esta plataforma tecnológica combinada com a nanotecnologia oferece possibilidades como a proteção e o controle da liberação; portanto, são excelentes estratégias para aumentar a biodisponibilidade de fármacos. O objetivo deste trabalho foi estudar as plataformas bio(mucoadesivas poliméricas baseadas em nanotecnologia para liberação controlada de fármacos, enfatizando suas propriedades, metodologias para mensuração e possíveis aplicações para diferentes vias de administração.

  17. Colinesterasas eritrocitaria y plasmática en trabajadores con enfermedades crónicas controladas y en usuarios de medicamentos Erythrocytic and plasmatic cholinesterases in workers with chronic controlled diseases and in users of medicines

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    Jaime Carmona Fonseca

    2006-01-01

    Full Text Available PROBLEMA: los valores fisiológicos de colinesterasas se conocen para personas y trabajadores sanos, pero poco se sabe de ellos cuando se trata de sujetos con enfermedades crónicas controladas, usualmente con medicamentos. ¿Cuál es el efecto de la enfermedad, de las drogas o de ambas en los niveles de colinesterasas? OBJETIVOS: medir las colinesterasas eritrocitarias y plasmáticas en trabajadores activos y asintomáticos, que estuvieran laborando, no expuestos a plaguicidas inhibidores de colinesterasas, que manifestaran padecer alguna enfermedad que estuviera controlada, con o sin tratamiento. METODOLOGÍA: como parte de un estudio descriptivo prospectivo, diseñado para obtener los valores de referencia en la población laboral activa de afiliados al Seguro Social, en Antioquia (Colombia, se aplicó una encuesta para identificar trabajadores con alguna enfermedad que estuviera controlada. La acetilcolinesterasa se midió por dos técnicas diferentes y la butirilcolinesterasa por tres procedimientos distintos. RESULTADOS: la muestra de la población laboral del valle de Aburrá y del Cercano Oriente Antioqueño la integraron 827 personas, de las cuales 19% dijeron tener alguna enfermedad. La prevalencia de enfermedad en Aburrá fue 30% y en Oriente 9% (p = 0.0000000. La lista de enfermedades contiene 13 problemas y los más frecuentes fueron hipertensión arterial (29%, «del hígado» (16%, anemia (10% y artritis (10%. Entre las 827 personas había 127 (15% que estaban recibiendo fármacos en el momento del estudio; 85% de los usuarios de fármacos empleaban uno solo y el resto usaban dos o más. El 8% tenían enfermedad y usaban fármacos (E+F+, 74% carecían de ambos fenómenos (E-F-, 11% tenían enfermedad pero no usaban medicamentos (E+F- y 7% no tenían enfermedad pero sí usaban drogas (E-F+. En cada estrato región-sexo, estos cuatro grupos se compararon en función de la colinesterasa, por cada una de las técnicas de medición, y

  18. 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

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    R. Rodríguez de la Torre

    2011-06-01

    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

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

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    F. Caba

    2010-05-01

    Full Text Available La analgesia epidural se ha convertido en una técnica rutinaria en el manejo perioperatorio de los pacientes quirúrgicos que se ha extendido fuera de los quirófanos y de las unidades de alta dependencia hacia las salas de hospitalización. La irrupción en este nuevo escenario ha mejorado la analgesia postoperatoria con aceptables márgenes de seguridad, lo que le ha servido para colocarse en un lugar predominante entre las pautas analgésicas de las Unidades de Dolor Agudo (UDA. La analgesia epidural con anestésicos locales y opioides frente a la sistémica con opioides ha presentado históricamente una superior eficacia analgésica, y una disminución de complicaciones derivadas de la atenuación del estrés quirúrgico y de la mejora en la función cardiorrespiratoria. Sin embargo, frente a estas ventajas la analgesia epidural también presenta inconvenientes como la hipotensión arterial o la retención urinaria, junto a las potencialmente graves derivadas del daño neurológico ocasionado por un hematoma epidural, una infección o una lesión directa del tejido nervioso. Si sus ventajas han resultado consistentes y fundamentadas, en este momento no lo parecen tanto. El avance que ha supuesto la cirugía mínimamente invasiva con altas más precoces, junto al desarrollo de estrategias multimodales, está conduciendo a un replanteamiento de la utilización de técnicas como la epidural y a una reevaluación de sus indicaciones. Las últimas evidencias nos inducen a pensar que la epidural probablemente haya tocado techo en el tratamiento del dolor postoperatorio y comenzará a perder terreno frente a otras técnicas igualmente efectivas, con menores complicaciones y efectos secundarios. Este será un proceso lento en el que deberá quedar asegurado que las alternativas analgésicas ofrecen realmente mejores resultados en cuanto a eficacia, seguridad, tolerabilidad y calidad de la recuperación desde la perspectiva del paciente

  20. Investimentos avaliados pelo método da equivalência patrimonial: erro na contabilização de dividendos quando existem lucros não realizados

    OpenAIRE

    Ariovaldo dos Santos; Itamar Miranda Machado

    2005-01-01

    Sempre que há transações comerciais envolvendo a investida e a investidora pode ocorrer a figura do Lucro Não Realizado - LNR. Quando a controlada vende qualquer ativo com lucro para a controladora e essa ainda não o revendeu para terceiros, dizse que, para o grupo econômico, esse lucro ainda não foi realizado. Ocorre que pode acontecer de a controlada distribuir esse lucro e, assim, para a controladora haverá o recebimento antecipado de dividendos. Este estudo aborda as práticas contábeis qu...

  1. Estudo comparativo dos efeitos hemodinâmicos e ventilatórios da ventilação controlada a volume ou a pressão, em cães submetidos ao pneumoperitônio Estudio comparativo de los efectos hemodinámicos y ventilatorios de la ventilación controlada a volumen o a presión, en perros sometidos a pneumoperitoneo Hemodynamic and ventilatory effects of volume or pressure controlled ventilation in dogs submitted to pneumoperitoneum. Comparative study

    Directory of Open Access Journals (Sweden)

    Antonio Roberto Carraretto

    2005-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ventilação com pressão controlada (PCV está disponível em aparelhos de anestesia, mas não existem estudos sobre o seu uso, durante o pneumoperitônio com o CO2 (PPC. O objetivo deste estudo foi avaliar a ventilação controlada a pressão bem como as alterações hemodinâmicas e ventilatórias durante o PPC, comparando-a com a ventilação controlada a volume (VCV convencionalmente utilizada. MÉTODO: Dezesseis cães anestesiados com tiopental sódico, citrato de fentanil e brometo de pancurônio, foram divididos aleatoriamente em dois grupos: VC - ventilação controlada a volume (n = 8 e PC - ventilação controlada a pressão (n = 8 Os parâmetros hemodinâmicos e ventilatórios foram monitorizados e registrados em 4 momentos: M1 (antes do PPC, M2 (30 minutos após PPC = 10 mmHg, M3 (30 minutos após PPC = 15 mmHg e M4 (30 minutos após a deflação do PPC. RESULTADOS: Com a aplicação do PPC ocorreu um aumento do volume corrente no grupo PC, aumento das pressões inspiratórias (máxima e de platô, diminuição da complacência proporcional ao aumento do PPC, aumento da freqüência cardíaca, manutenção da pressão arterial média com valores maiores no grupo VC em todos os momentos, aumento da pressão de átrio direito com diminuição significativa após a deflação, diminuição do pH sangüíneo durante o PPC com menor variação no grupo PC, maior estabilidade da pressão parcial do CO2 no sangue arterial no grupo PC, sem alterações da pressão parcial do O2 no sangue arterial. CONCLUSÕES: Apesar das diferenças de alguns parâmetros hemodinâmicos e ventilatórios, entre os dois modos de controle da ventilação, nas condições estudadas foi possível a utilização da ventilação controlada a pressão para procedimentos com a aplicação do PPC. É fundamental observar o controle rigoroso da ventilação alveolar, ajustando a pressão inspiratória para manter eliminação adequada do CO

  2. Depression in women infected with HIV Depressão em mulheres infectadas pelo HIV

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    Valéria Antakly de Mello

    2006-03-01

    Full Text Available OBJETIVE:The number of women with HIV infection has been on the rise in recent years, making studies of the psychiatric aspects of this condition very important. The aim of this study was to evaluate the prevalence of major depression in women with HIV infection. METHOD: A total of 120 women were studied, 60 symptomatic (with AIDS symptoms and 60 asymptomatic (without AIDS symptoms. Sociodemographic data were collected, and depressive disorders were identified. The instruments used to evaluate the depressive disorders were the SCID, DSM-IV, 17-item Hamilton depression scale, Hamilton depression scale for nonsomatic symptoms and the Beck depression scale. RESULTS: The prevalence of major depression was 25.8% and was higher in the symptomatic group than in the asymptomatic group (p = 0.002. CONCLUSIONS: The prevalence of major depressive episodes in women with HIV infection is high, and women with AIDS-related symptoms are more often depressed than are those who have never presented such symptoms.OBJETIVO: Devido ao aumento do número de mulheres infectadas pelo HIV, no Brasil e no mundo, torna-se necessária a realização de estudos que abordem os aspectos psiquiátricos dessa população. Esse estudo tem como objetivo avaliar a prevalência de depressão maior atual e outros transtornos depressivos em mulheres infectadas pelo HIV e comparar essa prevalência entre um grupo de pacientes sintomáticas e outro de assintomáticas. MÉTODO:Utilizou-se um desenho de estudo transversal que avaliou 120 mulheres portadoras do HIV divididas em dois grupos de 60 pacientes, de acordo com a presença, em algum momento da vida, de sintomas relacionados à AIDS (sintomáticas e assintomáticas. Foram avaliadas variáveis sociodemográficas e variáveis relacionadas aos transtornos depressivos. Foram utilizados na avaliação psiquiátrica dos transtornos depressivos o SCID-DSM-IV, escala de Hamilton-17, escala de Hamilton não somática e o inventário de

  3. Conseqüência da umidade relativa durante o armazenamento refrigerado e em atmosfera controlada na qualidade da maçã 'Gala' Consequence of the relative humidity during the cold storage and controlled atmosphere in the quality of 'Gala' apple

    Directory of Open Access Journals (Sweden)

    Auri Brackmann

    2005-10-01

    Full Text Available O objetivo do presente trabalho foi avaliar o efeito da umidade relativa no armazenamento refrigerado e em atmosfera controlada sobre a qualidade de maçãs 'Gala' colhidas tardiamente. Os tratamentos foram armazenamento refrigerado + alta umidade relativa (96%, armazenamento refrigerado + baixa umidade relativa (90%, atmosfera controlada + alta umidade relativa (96% e atmosfera controlada + baixa umidade relativa (90%. Os frutos de todos os tratamentos foram mantidos a 0,5°C e a condição de atmosfera controlada foi de 1,2kPa O2 + 3,0kPa CO2. Após sete meses de armazenamento, os frutos mantidos sob baixa umidade relativa (90% apresentaram menor incidência de rachaduras, porém maior índice de murchamento na retirada da câmara. Após cinco dias de exposição a 20°C, os frutos mantidos em baixa umidade relativa, tanto em armazenamento refrigerado quanto em atmosfera controlada, apresentaram menor incidência de podridão e rachaduras. A incidência de degenerescência da polpa e polpa farinácea não foi influenciada pela umidade relativa.The objective was to evaluate the effect of relative humidity in cold and controlled atmosphere storage on the quality of 'Gala' apples. The evaluated treatments were: cold storage + high humidity (96%, cold storage + low humidity (90%, controlled atmosphere + high humidity (96%, controlled atmosphere + low humidity (90%. Fruit of all treatments were stored at 0.5°C and the controlled atmosphere conditions was 1.2kPa O2 + 3.0kPa CO2. After seven months, fruit stored in low humidity had smaller incidence of fruit cracking, but higher shriveling index. After five days at 20°C, fruit maintained in cold storage and in controlled atmosphere with low humidity, showed lower decay incidence and less fruit cracking. Flesh breakdown and mealiness was not influenced by relative humidity in storage room.

  4. Anestesia venosa total em infusão alvo-controlada associada a bloqueio do nervo femoral para meniscectomia do joelho por acesso artroscópico Anestesia venosa total en infusión objeto-controlada asociada al bloqueo del nervio femoral para meniscectomía de la rodilla por acceso artroscópico Target-controlled total intravenous anesthesia associated with femoral nerve block for arthroscopic knee meniscectomy

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2009-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O aumento da popularidade de técnicas operatórias minimamente invasivas reduziu os tempos de recuperação de procedimentos que, anteriormente, eram associados a período de internação longo. Este trabalho apresenta técnica de anestesia geral venosa total com propofol e remifentanil combinada a bloqueio do nervo femoral, por acesso perivascular inguinal. MÉTODO: Foram incluídos 90 pacientes submetidos à artroscopia do joelho para meniscectomias. A indução anestésica foi feita com propofol em infusão alvo-controlada (IAC (alvo = 4 µg.mL-1 e com remifentanil em IAC (alvo = 3 ng.mL-1. As alterações das concentrações de propofol e remifentanil eram realizadas de acordo com a eletroencefalografia bispectral (BIS e a pressão arterial média (PAM. A ventilação era mecânica e controlada a volume e a via aérea mantida com máscara laríngea. Os valores das concentrações no local efetor de propofol e remifentanil eram obtidos através dos modelos farmacocinéticos dos fármacos, inseridos nas bombas de IAC e corresponderam a concentrações preditivas. Local efetor refere-se à área de ação dos fármacos. O tempo de alta hospitalar compreendeu o espaço de tempo entre a chegada do paciente na sala de recuperação até o momento da alta. RESULTADOS: As concentrações médias no local efetor (ng.mL-1, máximas e mínimas, de remifentanil foram de 3,5 e 2,4, respectivamente. As concentrações médias no local efetor (µg.mL-1, máximas e mínimas de propofol, foram respectivamente de 3,1 e 2,6. A vazão média de infusão de propofol e de remifentanil foi de 8,54 mg.kg-1.h-1 e de 0,12 µg.kg-1.min-1 , respectivamente. Os tempos de alta hospitalar foram, em média, de 180min. CONCLUSÕES: Todos os pacientes foram mantidos dentro dos parâmetros estabelecidos.JUSTIFICATIVA Y OBJETIVOS: El aumento de la popularidad de técnicas operatorias mínimamente invasivas, redujo los tiempos de recuperación de

  5. A acupuntura na analgesia do parto: percepções das parturientes La acupuntura en la analgesía del parto: percepciones de las parturientas Acupunture in childbirth analgesia: perceptions of the parturients

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    Jussara Gue Martini

    2009-09-01

    Full Text Available O estudo objetivou conhecer as percepções das parturientes atendidas na Maternidade do Hospital Universitário de Florianópolis (HU sobre a utilização da acupuntura na analgesia das dores do parto. Por meio de entrevistas com 31 parturientes, atendidas em procedimento de parto normal, em abril de 2005, obteve-se como resultados: 60% das protagonistas do estudo tem de 20 a 30 anos, são procedentes de Florianópolis em 90% dos casos. Uma grande parcela das mulheres atendidas na Maternidade não tem informações sobre o uso da acupuntura no controle das dores obstétricas, atingindo 95% das respostas. Contudo, 70% das entrevistadas acreditam na possibilidade de analgesia por acupuntura e estariam dispostas a experimentar caso disponibilizada na instituição. Tais resultados indicam a necessidade de ampliar os conhecimentos nesta área, bem como da capacitação das equipes de atenção ao parto no uso de outras formas de controle das dores obstétricas.El objetivo del presente estudio fue conocer las percepciones de las mujeres que dieron a luz atendidas en la Maternidad del Hospital Universitario de Florianópolis (HU sobre la utilización de la Acupuntura en la analgesia de los dolores del parto. Por medio de entrevistas con 31 parturientas, atendidas en procedimiento de parto normal, en abril de 2005, se obtuvo los siguientes resultados: 60% de las participantes del estudio tienen de veinte a treinta años, procedentes de Florianópolis en 90% de los casos. Un gran porcentaje de las mujeres atendidas en la Maternidad no tienen información sobre el uso de la acupuntura en el control de los dolores obstétricos, observado en 95% de las respuestas. De esta forma, 70% de las entrevistadas creen en la posibilidad de usar analgesias por acupuntura y estarían dispuestas a experimentar, de ser una posibiidade disponible en la institución. Tales resultados indican la necesidad de ampliar los conocimientos en esta área, así como, la necesidad

  6. Análisis de la analgesia en la baja de combate: Experiencia de la Sanidad Militar española Analgesia in the management of the combat casualty: Experience of the Spanish Medical Service

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    R. Navarro Suay

    2012-03-01

    Full Text Available Antecedentes y Objetivos: La analgesia del herido ha jugado un papel trascendental en la medicina militar. En la actualidad, continúa siendo un reto médico, táctico y logístico dentro del tratamiento integral de la baja en combate. El objetivo de este estudio es valorar la homogeneidad de los fármacos analgésicos administrados, del momento de inicio del tratamiento, del número y tipos de vías de acceso para administración de analgesia, así como del tipo de anestesia realizada en las bajas por arma de fuego o por artefacto explosivo atendidas en el ROLE 2E español de Herat (Afganistán entre 2005 y 2008, siguiendo un índice de gravedad anatómico (NISS de las lesiones. Material y métodos: Se realiza un estudio observacional, retrospectivo, obteniendo una muestra de 256 pacientes. Resultados: Los fármacos analgésicos más empleados fueron los AINEs (73%, seguidos de los mórficos mayores (44%, coadyuvantes (29%, mórficos menores (21% y ketamina (12%. La analgesia se realizó a nivel prehospitalario en un 61% y a nivel intrahospitalario en un 31% de los casos. La vía de administración más frecuente fue la intravenosa (79%. En el 75% sólo se consiguió un acceso para medicación analgésica. El procedimiento anestésico más empleado fue la anestesia general (32%. Conclusiones: El tratamiento analgésico prestado a las bajas en combate de la muestra es homogéneo en cuanto a los fármacos empleados, el tipo y número de vías de administración conseguidas. Sin embargo es heterogéneo en cuanto al tipo de AINE elegido y al inicio en la administración de los fármacos analgésicos.Antecedents and Objectives: The analgesia of the wounded has played a vital role in military medicine. Nowadays it still is a medical, tactical and logistical challenge in the integral management of the combat casualty. The objective of this study is to evaluate the homogeneity of the analgesic drugs used, starting point of the treatment, number and

  7. Os radicais livres e o dano muscular produzido pelo exercício: papel dos antioxidantes

    OpenAIRE

    Alfredo Córdova; Francisco J. Navas; José Kawazoe Lazzoli

    2000-01-01

    O exercício físico intenso e contínuo é acompanhado pela produção de radicais livres, que provocam uma alteração das membranas celulares, o que causa uma lesão acompanhada por um processo inflamatório ao nível das fibras musculares. Várias causas foram sugeridas para estas alterações, entre as quais o alto grau de estresse provocado pelo exercício, alterações da microcirculação, produção de metabólitos tóxicos e depleção intramuscular dos substratos energéticos. O rápido desenvolvimento da le...

  8. Sucesso escolar, adaptação pessoal, familiar, escolar e social percebidos pelos adolescentes algarvios

    OpenAIRE

    Lourenço Marcos Gonçalves, Maria Vítor

    2016-01-01

    O Sucesso Escolar é um fenómeno que serve de barómetro sobre o desenvolví mentó das sociedades democráticas. Todavía, parece existir mais produçâo literária que investigaçôes de campo, por isso a necessídade de investigar o fenómeno. Este estudo foi desenvolvido na regiáo Portuguesa do Algarve. Utilizámos o termo Sucesso Escolar como fazendo referência a processos e resultados que identificam se os alunos respondem satisfatoriamente às exigéncias determinadas pelo sistema escolar. A partir de...

  9. Auto cuidado no tratamento pelo método de Ilizarov: um estudo de caso

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    Marisa Toshiko Ono Tashiro

    1995-03-01

    Full Text Available As autoras realizaram um estudo de caso com aplicação do modelo de auto cuidado de Dorothea Orem, no tratamento pelo método de Ilizarov, utilizando cuidados e orientações específicas para a recuperação e prevenção de complicações. A operacionalização do estudo constou de procedimentos relativos às demandasdecuida dos universais e terapêuticos, durante a hospitalização. As demandas foram detectadas no pré-operatório e os cuidados desenvolvidos no pós-operatório, facilitando ao paciente o aprendizado e a realização dos procedimentos necessários a dar continuidade dos mesmos no seu domicílio.

  10. Programa de Educacao pelo Trabalho para Saude: experiencia de transformacao do ensino e pratica de enfermagem

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    Debora de Souza Santos

    2013-12-01

    Full Text Available Trata-se de um relato de experiência de tutoras de enfermagem do Programa de Educação pelo Trabalho na Saúde (PET-Saúde da Universidade Federal de Alagoas, entre maio de 2009 a abril de 2010. O objetivo do PET-Saúde enfermagem foi desenvolver ações de educação em saúde voltadas para as necessidades das comunidades atendidas pelas Unidades de Saúde da Família em Maceió, Alagoas. Para isso, foi realizado o planejamento em saúde orientado pela metodologia da problematização. As atividades resultaram em mudança na aprendizagem dos estudantes e na prática das enfermeiras do PET-Saúde, indicando a importância deste programa para o ensino e prática de enfermagem.

  11. Toxicidade ocular causada pelo tamoxifeno: relato de caso Ocular toxicity caused by tamoxifen: case report

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    Eliane Terumi Inada

    2005-08-01

    Full Text Available O objetivo desse trabalho é relatar um caso de toxicidade ocular pelo tamoxifeno. Para isso, aferiu-se a melhor acuidade visual corrigida de ambos os olhos em tabela de Snellen. Foram realizados biomicroscopia do segmento anterior, refração, oftalmoscopia, angiofluoresceinografia e retinografia numa paciente de 63 anos, sexo feminino, cor branca, em uso de tamoxifeno 20 mg/dia há 4 anos, com acuidade visual corrigida de 20/70 e 20/40. A biomicroscopia do segmento anterior apresentava ceratopatia verticilata e catarata nuclear e cortical posterior de 1+/4 em ambos os olhos. À oftalmoscopia, foi verificado alteração do brilho macular de ambos os olhos. E a angiofluoresceinografia mostrou hiperfluorescência na área macular em fase precoce (defeito em janela. Relata-se um caso de ceratopatia e maculopatia causadas pelo tamoxifeno.To report tamoxifen ocular toxicity. The best visual acuity was measured in both eyes with Snellen chart, slit-lamp examination of anterior segment, refraction, dilated fundus examination, fluorescein angiography and retinography in a 63-year-old patient, female, white, using tamoxifen 20 mg/day for 4 years, with 20/70 and 20/40 corrected visual acuity. The anterior segment examination showed corneal linear subepithelial opacity inferior to the visual axis and nuclear and posterior cortical cataract (1+/4 in both eyes. Fundus examination showed alteration of macular color in both eyes. Fluorescein angiography presented hyperfluorescence in the macular area at an early phase (window defect. Report of keratopathy and maculopathy caused by tamoxifen.

  12. A GESTÃO DO TERRITÓRIO PELO CAPITAL SUCROALCOOLEIRO NO NORTE DO PARANÁ

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    Marcos Antonio de Souza

    2013-02-01

    Full Text Available Toda produção econômica possui uma determinada territorialidade, cuja gestão deste território está orientada no desenvolvimento de estratégias que primem pela rentabilidade da produção, prioritariamente em patamares diferenciais. Partindo-se da premissa de que o território não é uma mera localização, a agroindústria canavieira não se localiza pura e simplesmente em uma base física qualquer. Antes, há uma seletividade espacial marcada pelas disputas territoriais e a partir destas há o exercício do controle sob os elementos necessários para realizar a sua produção, subordinando a terra, a força de trabalho, os recursos naturais ao seu negócio que prima pela reprodução ampliada do capital. Trata-se na verdade de um conjunto de estratégias espaciais, onde o poder econômico ao controlar o território, reserva para si a gestão deste no âmbito do pacto social engendrado pelos grupos hegemônicos, resultando em um território gerido e ordenado pelo capital que aí se territorializou. Nesse contexto, este trabalho busca apresentar as principais estratégias espaciais dos agroindustriais do setor canavieiro desenvolvidas nas últimas três décadas no Norte do Paraná.

  13. O adoecimento pelo cancer de laringe The illness narrative for larynx cancer

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    Márcia Maria Fontão Zago

    2001-06-01

    Full Text Available Com a finalidade de aprimorar a assistência ao laringectomizado, este estudo teve o objetivo de compreender o adoecimento pelo câncer de laringe na visão do paciente e sua família. Participaram do estudo 14 pacientes laringectomizados e familiares, em diferentes períodos pós-operatórios. Na análise das narrativas identificamos categorias que foram interpretadas sob a visão antropológica da cultura. Na interpretação dos participantes, o processo é permeado pelo sofrimento, pela busca de estratégias de enfrentamento, pela valorização de sobreviver à cirurgia, ou seja, pressupostos culturais que diferem do modelo biomédico dos profissionais e que devem ser considerados na sua reabilitação.With the purpose of improving the care of laryngectomized patients, the aim is to understand the illness experience of patients and families of having larynx cancer. The participants were 14 laryngectomized patients and their families, in different post-surgical periods. The narrative analysis searched for categories which were understood on the basis of an anthropological focusing the culture. The understanding that the participants had of the illness experience of having a larynx cancer shows us that this process is one of suffering, of searching of strategies of coping, of evaluating the survival to the surgical treatment, which were based on the cultural system, which is different from the biomedical model of the health professionals and they must be considered in the approach for the rehabilitation.

  14. Relationship Between and Laser Acupuncture Analgesia and the Function of Mast Cells in Adjuvant Arthritis Rats Treated by Acupuncture%Relationship Between and Laser Acupuncture Analgesia and the Function of Mast Cells in Adjuvant Arthritis Rats

    Institute of Scientific and Technical Information of China (English)

    程珂; 丁光宏; 沈雪勇; 吴凡

    2009-01-01

    Objective:To observe the analgesia effect and of low-level combined- and single-laser irradiation on Zusanli (ST 36) in rats and the relationship between mast cell degranulation and laser acupuncture analgesia.Methods: A total of 66 Sprague Dawley (SD) rats were randomly assigned into normal control,model control,sham irradiation,10.6 μm laser (220 mW,40 Hz) 650nm laser(36mW,continuous),combined laser (10.6 μm+ 650 nm) groups.Arthritis mode 1 was established by injection of Complete Freund's Adjuvant (0.05 mL) into the left ankle joint.The paw withdrawal latency (PWL) was detected with a radiant heat algesimeter.Zusanli (ST 36) was irradiated with sham,single or combined laser for 30 min.After sacrifice under anesthesia (1% embutal),tissues of Zusanli (ST 36) area were sampled,sliced (5 μm) and stained with Toluidine Blue for skin for observing the mast cell degranulation.Results:Compared with model control and sham group,the pain threshold increased significantly in 650nm and combined laser groups (P<0.01),while remained no significant difference in 10.6 μm group.Compared with model and sham group,the degranulation ratios of mast cells in 650nm and combined laser group were significantly higher (P<0.001),while remained no significant difference in 10.6 μm group.The linear correlation coefficient between degranulation ratios of mast cells and PWL after laser acupuncture is 0.737 (P<0.001).Conclusion:Both 650 nm and combined laser stimulation of Zusanli (ST 36) can effectively raise pain threshold,and enhance degranulation ratio of mast cells at the stimulated acupoint.The result also suggested a linear correlation between degranulation ratio of mast cell and analgesia effect.

  15. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels).

    Science.gov (United States)

    Lavand'homme, P; Roelants, F

    2009-01-01

    Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). A questionnaire was mailed to the departmental chair of the hospitals with an obstetric unit, both in university and non-university centers (total of 53 centers). The questionnaire evaluated the availability of EA, the alternatives used when EA was contraindicated, the use of opioid-based PCIA for labor analgesia as well as opioid preference and doses, and finally the reasons for not using opioid PCIA. The response rate was 67.5% (36 centers). Among the responding hospitals, EA was available for 68% (range 25-85%) of labors and deliveries. When EA was not available or contraindicated, a parenteral opioid (piritramide, tramadol or pethidine) was proposed in 19% (7/36) of the centers, Entonox in 11% (4/36), a pudendal block by obstetricians in 28% (10/36) and non-pharmacologic alternatives (i.e. hypnosis, sophrology, baths and massages) in 19% (7/36). In 28% (10/36) of the centers however, no analgesic alternative was proposed. Opioid PCIA was employed in 36% (13/36) of the centers and for an additional 11% (4/36) only in case of intrauterine death. Remifentanil was the first choice (76.5% of the PCIA), followed by sufentanil (23.5%). Other opioids (piritramide, morphine, fentanyl) and ketamine were also administered by PCIA. Forty-five percents of the centers reported never using opioid PCIA by either lack of knowledge (7%), fear of maternal or fetal side effects (48%) and unability to provide a correct supervision of the parturient during PCIA use (48%), opposition from

  16. Síndrome de Horner y bloqueo del plexo braquial ipsilateral en un caso de analgesia epidural para el trabajo del parto Horner´s sydrome and ipsilateral brachial plexus block during an epidural analgesia labour procedure

    OpenAIRE

    J. Avellanosa; Vera, J.; P. Morillas; E. Gredilla; F. Gilsanz

    2006-01-01

    El Síndrome de Horner es una complicación de la anestesia epidural que aparece más frecuentemente en pacientes obstétricas debido a los cambios fisiológicos y anatómicos propios del embarazo; sin embargo, su incidencia es baja, y sólo se han descrito dos casos previos asociando un bloqueo del plexo braquial. Presentamos el caso de una gestante de 23 años que precisó analgesia epidural para el trabajo de parto. Tras comprobar la correcta colocación del catéter se administró una dosis inicial e...

  17. Controle da transmissão da doença de Chagas, pelo combate aos vetores, com bendiocarb, feito pelos habitantes

    Directory of Open Access Journals (Sweden)

    Italo A. Sherlock

    1984-06-01

    Full Text Available Experimentamos o novo inseticida bendiocarb para o combate ao Panstrongylus megistus, principal vetor da doença de Chagas, em uma área endêmica do Estado da Bahia, Brasil. Uma das partes da experiência constou da aplicação de 0,4 g/m² de bendiocarb a 80% pelas equipes de guardas borrifadores oficiais. A taxa de infestação das casas foi reduzida de 18% para 7%, seis meses após a aplicação do inseticida, e a densidade de P. megistus caiu de 7 para 1,5 exemplares por hora. A outra parte constou da utilização da mão-de-obra dos habitantes na inspeção de suas casas para triatomíneos, da aplicação por meio de uma pequena bomba manual, de bendiocarb a 20%, sempre que observassem triatomíneos. A taxa de infestação das casas foi reduzida de 48% para 14% e a densidade de P. megistus caiu de 12 para menos de 1 exemplar por hora. Apesar da concentração mais fraca, o bendiocarb aplicado com a colaboração da população, apresentou resultados mais eficientes, provavelmente devido à constante vigilância com que ficou a área, havendo conseqüentemente, maior freqüência na aplicação do inseticida. O método de combate aos vetores com a participação da população mostrou-se mais eficiente e menos dispendioso. Dessa forma, se adotado pelos serviços de combate às endemias no Brasil, talvez venha a ser a solução para a descontinuidade das campanhas contra a doença de Chagas.

  18. Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Lingxi Wu; Handong Zou; Qingshan Zhou; Zhongchun Liu; Bangchang Cheng

    2008-01-01

    BACKGROUND: Preemptive analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE: To treat psychiatric patients with intravenous (i.v.) injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN: A randomized controlled observation. SETTING: Renmin Hospital of Wuhan University.PARTICIPANTS: A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group (n = 60) and treatment group (n = 60). In the control group, there were 42 males and 18 females, aged 17–50 years, with a mean age of (34 ± 11) years. The patients weighed 50–70 kg, with a mean body mass of (63 ± 18) kg. In the treatment group, there were 40 males and 20 females, aged 20–54 years, with a mean age of (36 ± 13) years. The patients weighed 48–72 kg, with a mean body mass of (64 ± 16) kg. Approval was obtained from the Hospital's Ethics Committee. Informed consents were obtained from the patients' relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus (CORPERATION, USA) was used.METHODS: ① Treatments: In the control group, the patients were anesthetized by I.v. Injection of propofol (AstraZeneca, Italy, No.CN309) containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the

  19. Preventive analgesia: Effect of small dose of ketamine on morphine requirement after renal surgery

    Directory of Open Access Journals (Sweden)

    Beena Parikh

    2011-01-01

    Full Text Available Background : N-methyl D-Aspartate (NMDA receptors seem to be responsible for pain memory and their blockade can contribute significantly in prevention of pain. This study was conducted to evaluate the preventive effect of small dose of ketamine, a NMDA receptor blocker, given before skin incision in renal surgery, with the aim to compare analgesic efficacy, intra operative and post-operative side effects. Materials and Methods : In a prospective double-blind study, 60 American Society of Anesthesiologists (ASA risk I and II adult patients scheduled for elective open renal surgeries by flank incision were randomly divided in two groups. Ketamine group (group K received ketamine 0.15 mg/kg intravenously, 30 minute before start of surgery followed by infusion of ketamine 2 mcg/kg/min till start of skin closure. Control group (group C received normal saline in place of ketamine. Both groups received morphine 0.15 mg/ kg i.v. at the time of skin closure. The analgesic efficacy was judged by visual analogue scale (VAS at rest and on movement, time to first analgesic and morphine consumption in 24 hours. Opioid or ketamine related side effects were also recorded. Results : Patients in ketamine group had significantly lower VAS score, longer time to first analgesic (21.6 ± 0.12 Vs 3.8 ± 0.7 hrs, and lower morphine consumption (5.8 ± 1.48 Vs 18.1 ± 1.6 mg in 24 hours. There were no demonstrable side effects related to ketamine in group K whereas incidence of nausea and vomiting was higher in group C. Conclusion : Our results demonstrate that small dose of ketamine decreases post-operative pain, reduces morphine consumption, and delays patients request for analgesia beyond the clinical duration of action of ketamine after open renal surgery.

  20. Sucrose-induced analgesia during early life modulates adulthood learning and memory formation.

    Science.gov (United States)

    Nuseir, Khawla Q; Alzoubi, Karem H; Alabwaini, Jehad; Khabour, Omar F; Kassab, Manal I

    2015-06-01

    This study is aimed at examining the long-term effects of chronic pain during early life (postnatal day 0 to 8weeks), and intervention using sucrose, on cognitive functions during adulthood in rats. Pain was induced in rat pups via needle pricks of the paws. Sucrose solution or paracetamol was administered for analgesia before the paw prick. Control groups include tactile stimulation to account for handling and touching the paws, and sucrose alone was used. All treatments were started on day one of birth and continued for 8weeks. At the end of the treatments, behavioral studies were conducted to test the spatial learning and memory using radial arm water maze (RAWM), as well as pain threshold via foot-withdrawal response to a hot plate apparatus. Additionally, the hippocampus was dissected, and blood was collected. Levels of neurotrophins (BDNF, IGF-1 and NT-3) and endorphins were assessed using ELISA. The results show that chronic noxious stimulation resulted in comparable foot-withdrawal latency between noxious and tactile groups. On the other hand, pretreatment with sucrose or paracetamol increased pain threshold significantly both in naive rats and noxiously stimulated rats (Psucrose treatment prevented such impairment (PSucrose significantly increased serum levels of endorphin and enkephalin. Chronic pain decreased levels of BDNF in the hippocampus and this decrease was prevented by sucrose and paracetamol treatments. Hippocampal levels of NT-3 and IGF-1 were not affected by any treatment. In conclusion, chronic pain induction during early life induced short memory impairment, and pretreatment with sucrose prevented this impairment via mechanisms that seem to involve BDNF. As evident in the results, sucrose, whether alone or in the presence of pre-noxious stimulation, increases pain threshold in such circumstances; most likely via a mechanism that involves an increase in endogenous opioids.