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Sample records for analgesia postoperatoria con

  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

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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

  2. 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.

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

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    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. 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

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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

  5. Analgesia postoperatoria con lornoxicam frente a metamizol en cirugía mayor ambulatoria: Estudio prospectivo aleatorio Postoperative analgesia with lornoxicam versus metamizol for outpatient major surgery: A randomized prospective study

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    B. Tapia

    2005-10-01

    Full Text Available Objetivos: Comparar la eficacia analgésica postoperatoria en cirugía mayor ambulatoria de dos fármacos analgésicos no opioides: metamizol, habitualmente utilizado en nuestro medio, frente a lornoxicam, introducido recientemente para uso clínico. Métodos: Estudio prospectivo y aleatorio. Incluimos 73 pacientes programados para un procedimiento de cirugía mayor ambulatoria. Al final de la cirugía administramos una dosis única de metamizol i.v. a todos los pacientes. Cuando los pacientes comenzaron la tolerancia administramos medicación analgésica oral aleatorizando los pacientes en dos grupos: en el grupo lornoxicam (n = 35 un comprimido de lornoxicam 8 mg cada 12 horas y en el grupo metamizol (n = 38 un comprimido de metamizol 575 mg cada 8 horas. Evaluamos el dolor postoperatorio en cuatro momentos distintos del proceso postoperatorio: en la Unidad de Reanimación al final de la cirugía, al inicio del tratamiento analgésico con la tolerancia oral, al alta hospitalaria, y a las 48 horas tras la cirugía. Utilizamos la escala analógica visual (EVA, una escala numérica sencilla para valorar el dolor por encuesta telefónica a las 48 horas, la satisfacción del paciente al final del procedimiento, la opinión del paciente sobre la medicación recibida, y la necesidad de medicación de rescate. Resultados: No encontramos diferencias estadísticamente significativas en el EVA en la Unidad de Reanimación, en el inicio del tratamiento analgésico oral, ni en la valoración del dolor a las 48 h de la cirugía. El EVA del alta domiciliaria fue menor en el grupo metamizol que en el grupo lornoxicam (p Objectives: To compare the analgesic effectiveness for outpatient major surgery of two non-opiate analgesic drugs: metamizol, frequently used in our setting, versus lornoxicam, recently introduced in the clinical practice. Methods: Prospective and randomized study in 73 patients scheduled for outpatient major surgery. At the end of the

  6. Analgesia postoperatoria en la cirugía del pie y tobillo mediante bloqueo ciático poplíteo lateral con ropivacaína Postoperative analgesia in foot and ankle surgery through lateral popliteal sciatic blockade with ropivacaine

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    G. Valladares

    2004-03-01

    Full Text Available Introducción: El bloqueo del nervio ciático en la fosa poplítea proporciona una adecuada y prolongada analgesia postoperatoria en la cirugía del pie y tobillo. La principal ventaja del abordaje lateral es que no es preciso modificar la posición de decúbito supino del paciente para la realización de la técnica, mientras que en el abordaje posterior el paciente ha de colocarse en decúbito prono, lo cual puede resultar difícil e incluso desaconsejable en determinadas situaciones: estados avanzados de gestación, inestabilidad hemodinámica y ventilación mecánica. Material y método: Se incluyeron pacientes valorados con riesgo anestésico ASA I-II, programados para cirugía ortopédica-traumatológica del pie o tobillo. Se realizó un bloqueo del nervio ciático en la fosa poplítea mediante abordaje lateral según la técnica descrita por Vloka J.D y Hadzic A, empleándose una aguja para neuroestimulación, biselada de calibre 22G x 80 mm. Se consideró como respuesta motora adecuada cualquier movimiento del pie o dedos a intensidad inferior a 0,4 mA y superior a 0,1 mA. La observación de una respuesta motora a intensidad de estimulación de 0,1 mA se consideró como localización intraneural de la aguja. Se inyectaron 40 mL de ropivacaína 0,5%. Las principales variables que se registraron a las 8, 16 y 24 horas tras la realización del bloqueo fueron el dolor en reposo y en movimiento según la escala visual analógica (EVA de 0-10 y el grado de satisfacción. Resultados: Se incluyeron 21 pacientes ASA I-II. El dolor medio en reposo fue valorado como de intensidad 1 en las primeras 8 horas y de intensidad 3 a las 16 h y 24 h tras la realización del bloqueo. El dolor medio con el movimiento articular fue valorado como de intensidad 2 a las 8 h y de intensidad 4 a las 16 h y 24 h tras el bloqueo. El grado de satisfacción medio referido por los pacientes fue de 9. Discusión: El abordaje lateral, como en la serie que presentamos, nos

  7. Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína Comparación entre tres técnicas regionales de analgesia postoperatoria en niños con ropivacaina Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

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    Ana Maria Menezes Caetano

    2006-12-01

    ropivacaína para la analgesia postoperatoria en niños. MÉTODO: Se estudiaron 87 niños del sexo masculino, con edad entre 1 y 5 años, sometidos a herniorrafias inguinales electivas unilaterales. Los niños recibieron aleatoriamente la PS, el BIHII o la IFO. Se investigó la necesidad de analgésico en el postoperatorio, el tiempo necesario para su primera dosis, la intensidad de dolor y el grado de bloqueo motor. RESULTADOS: En el grupo de la IFO se observó una mayor necesidad de analgésicos, y una mayor intensidad de dolor en las 1ª y 2ª horas, cuando se comparó con la PS y el BIHII. Apenas niños sometidos a PS presentaron bloqueo motor de grado moderado. El tiempo promedio de la necesidad de la primera dosis de analgésico fue similar entre los grupos. CONCLUSIONES: El BIHII presentó una superioridad sobre la IFO, especialmente en las primeras dos horas del postoperatorio. As tres técnicas anestésicas pueden ser utilizadas con seguridad y eficacia en el control de dolor postoperatorio de herniorrafia inguinal en niños.BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE with ilioinguinal/iliohypogastric nerve block (IINB and infiltration of surgical wound (ISW with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups

  8. Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas

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    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 (p<0,001, con una duración superior a las 24h (p<0,01 y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01, iniciaron la rehabilitación más precozmente (31,2±5,01h vs 44,62±7,9h (p<0,001 y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente vs 30,26±1,88€/paciente no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de los EVAs medio, grado de satisfacción ni gasto económico entre los pacientes que recibieron alg

  9. Postoperative urinary retention: evaluation of patients using opioids analgesic Retención urinaria post-operatoria: evaluación de pacientes en tratamiento analgésico con opioides Retenção urinária pós-operatória: avaliação de pacientes em uso de analgesia com opióides

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    Maria do Carmo Barretto de Carvalho Fernandes

    2007-04-01

    Full Text Available The study aimed to determine the occurrence of urinary retention in patients using opioid analgesic and to describe the method used for vesical relief. A prospective and consecutive series of 1,316 patients undergoing surgery from September 1999 to April 2003 and using opioids post surgery were studied. From the 1,136 patients, 594 did not use urinary catheters pre-surgery. From these 594 patients, 128 (22% suffered post operative urinary retention. Urinary retention was significantly related to the use of continuous epidural analgesia (p=0.009. About 69% of patients experiencing urinary retention post surgery returned to spontaneous micturition following a single catheterization. The incidence found of urinary retention was similar to the literature, more frequent in men who received continuous epidural analgesia. The findings suggest orientation and careful nursing team observation of post operative micturition, emphasizing the intermittent aseptically catheterization for urinary retention in order to prevent potential complications of the urinary tract.Los objetivos de este estudio fueron determinar la incidencia de retención urinaria post-operatoria en pacientes que se encontraban en uso de analgésicos opioides, así como describir el método utilizado en el vaciado vesical. Se trata de una serie prospectiva y consecutiva de 1.316 pacientes quirúrgicos, estudiados de septiembre de 1999 a abril de 2003. De ellos, 594 pacientes no usaron cateterismo de demora en el pre-operatorio. Así mismo, 128 pacientes de este grupo presentó retención urinaria, con una incidencia del 22% (128/594. Hubo una asociación estadísticamente significativa entre la ocurrencia de retención urinaria y el uso de analgesia epidural continua (p=0,009. El 69% de los pacientes presentó una micción espontánea luego de haber realizado apenas un cateterismo. La incidencia de retención urinaria encontrada es semejante a la descrita en la literatura, siendo m

  10. 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

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    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

  11. 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

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    Leonardo Teixeira Domingues Duarte

    2009-06-01

    diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in

  12. Análisis de la eficacia y seguridad del bloqueo iliofascial continuo para analgesia postoperatoria de artroplastia total de rodilla Analysis of the efficiency and safety of the ileofascial block for postoperatory pain after total knee arthroplasty

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    J. López González

    2012-10-01

    Full Text Available Objetivo: la importancia del dolor agudo postoperatorio radica en su alta frecuencia, en su inadecuado tratamiento y en las repercusiones que tiene en la evolución y en la recuperación del paciente. El bloqueo iliofascial puede ser una técnica adecuada para analgesia postoperatoria en la artroplastia total de rodilla. El objetivo de este estudio es valorar la eficacia y seguridad del bloqueo iliofascial, en comparación con el bloqueo epidural, a efectos de analgesia postquirúrgica en pacientes sometidos a artroplastia total de rodilla bajo anestesia subaracnoidea. Se valoró además si la realización del bloqueo iliofascial es una técnica analgésica segura, las complicaciones derivadas de la misma, los efectos secundarios y el grado de satisfacción del paciente. Material y métodos: estudio multicéntrico, prospectivo, aleatorio, observacional, controlado, con evaluador ciego, en 54 pacientes, adultos, ASA I-III, de ambos sexos, sometidos a cirugía de artroplastia total de rodilla bajo anestesia intradural. Los pacientes incluidos en el estudio se dividieron en dos grupos, BIF y BE. En el grupo BIF (n = 27 se colocó un catéter iliofascial, mientras que en el otro grupo BE (n = 27 se colocó un catéter epidural lumbar (a nivel L3-L4, en ambos casos para la analgesia postoperatoria continua. Ambos grupos recibieron el mismo protocolo analgésico con paracetamol y metamizol pautados, y rescate con bolos de morfina intravenosa. Se utilizó t-Student para comparar las variables cuantitativas. Se consideró significativo (p Objective: the importance of acute postoperative pain lies in its high frequency, where inadequate treatment and the impact it has on the evolution and the patient's recovery. Iliofascial block may be a suitable technique for postoperative analgesia after total knee arthroplasty. The aim of this study is to assess the efficacy and safety of the blockade iliofascial compared with epidural analgesia in postoperative

  13. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report

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    Ranger Cavalcante da Silva

    2006-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apresentar um caso de paciente com hematoma peridural, na vigência do uso de cateter peridural e heparina de baixo peso molecular, seu quadro clínico e tratamento. RELATO DO CASO: Paciente do sexo feminino, 75 anos, submetida à fixação de coluna lombar por via anterior, que desenvolveu no pós-operatório quadro clínico de paralisia progressiva nos membros inferiores, com perda de sensibilidade, sem apresentar dor radicular intensa. O tratamento foi descompressão medular imediata, com drenagem e limpeza cirúrgica de hematoma peridural, que se estendia da quinta até a décima vértebra torácica. Após a drenagem do hematoma a paciente recuperou gradualmente a força nos membros inferiores, recebeu alta em 10 dias com quadro de disfunção esfincteriana. Após três meses o quadro regrediu e não houve seqüela neurológica definitiva. CONCLUSÕES: O rápido diagnóstico com intervenção cirúrgica precoce é o tratamento mais eficaz para redução de lesão neurológica, em pacientes que desenvolvem hematoma peridural no pós-operatório. A utilização de heparina de baixo peso molecular, na vigência do uso de cateter peridural, exige a adesão estrita a protocolos estabelecidos, para que se reduzam os riscos do desenvolvimento de hematoma peridural.JUSTIFICATIVA Y OBJETIVOS: presentar el caso de una paciente con hematoma peridural, con uso actual de catéter peridural y heparina de bajo peso molecular, su cuadro clínico y tratamiento. RELATO DEL CASO: Paciente de 75 años, sometida a la fijación de columna lumbar por vía anterior, que desarrolló en el postoperatorio un cuadro clínico de parálisis progresiva en los miembros inferiores, con pérdida de la sensibilidad, sin presentar dolor radicular intenso. El tratamiento fue descompresión medular inmediata, con drenaje y limpieza quirúrgica de un hematoma peridural, que se extendía desde la quinta hasta la décima vértebra toráxica. Después del

  14. Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia pós-operatória em colecistectomias videolaparoscópicas Administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia postoperatoria en colecistectomías videolaparoscópicas Intraperitoneal administration of 50% enantiomeric excess (S75-R25 bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

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    João Batista Santos Garcia

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O efeito analgésico de infusões intraperitoneais de anestésicos locais após colecistectomia videolaparoscópica é controverso e os resultados descritos vão de alívio considerável à pequena redução da dor. O objetivo deste estudo foi avaliar a eficácia da administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para o alívio da dor no pós-operatório de colecistectomia videolaparoscópica. MÉTODO: Estudo aleatório, placebo-controlado e duplamente encoberto com 40 pacientes submetidos à colecistectomia videolaparoscópica divididos em dois grupos: GI (n = 20 que recebeu 80 mL de solução de bupivacaína S75-R25 a 0,125% intraperitoneal no fim da operação; GII (n = 20 que recebeu 80 mL de solução fisiológica a 0,9%. Ambos os grupos receberam 40 mg de tenoxicam e 30 mg.kg-1 de dipirona, por via venosa, pouco antes do fim da operação. A analgesia no pós-operatório (PO foi feita com tramadol. Foram avaliados os escores de dor em repouso, ao sentar e à manobra de Valsalva, segundo a escala numérica ao despertar e 2, 4, 8, 12 e 24 horas no PO; a presença de dor no ombro; o tempo para a primeira solicitação do analgésico; e o seu consumo cumulativo. RESULTADOS: Houve diferença estatística significativa entre os escores de dor às 12 horas no PO com o paciente em repouso (GI JUSTIFICATIVA Y OBJETIVOS: El efecto analgésico de infusiones intraperitoneales de anestésicos locales después colecistectomía videolaparoscópica es controvertido y los resultados descritos van desde el alivio considerable a la pequeña reducción del dolor. El objetivo de este estudio fue evaluar la eficacia de la administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para el alivio del dolor en el postoperatorio de colecistectomía videolaparoscópica. MÉTODO: Estudio aleatorio, placebo-controlado y doblemente encubierto con

  15. Bloqueos nerviosos periféricos en la extremidad inferior para la analgesia postoperatoria de la artroplastia total de rodilla

    OpenAIRE

    Gonzalo Pellicer, Inmaculada; Gómez Gómez, Roberto; Martínez Delgado, Fernando

    2014-01-01

    INTRODUCCIÓN: El control del dolor en el postoperatorio inmediato de la artroplastia total de rodilla (ATR) es básico tanto para la precoz recuperación y movilidad de la extremidad como para el confort del paciente, puesto que se trata de una de las intervenciones más dolorosas que se realizan. Según los últimos estudios publicados, el bloqueo del nervio femoral, ya sea con una punción única o dejando un catéter con bloqueo continuo podría ser la técnica de elección para el control del dolor ...

  16. 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.

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    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

  17. Analgesia pós-operatória plexular contínua: estudo dos efeitos colaterais e do risco de infecção dos cateteres Analgesia postoperatoria plexular continua: estudio de los efectos colaterales y de riesgo de infección de los catéteres Postoperative continuous plexular analgesia: a study on the side effects and risk factors of catheter infection

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    Juliano Rodrigues Gasparini

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia pós-operatória foi muito valorizada nos últimos anos. Os cateteres plexulares são boa opção para analgesia de qualidade com a mínima repercussão sistêmica. O presente estudo visou a avaliar a ocorrência de efeitos colaterais e complicações em analgesia pós-operatória com cateteres plexulares e identificar fatores de risco para colonização bacteriana nos cateteres. MÉTODO: Pacientes submetidos a operações ortopédicas entre março de 2005 e janeiro de 2007 receberam analgesia por cateteres de plexo. Foi avaliada a ocorrência de efeitos colaterais e de complicações com o uso da técnica. Em parte dos casos foi feita cultura da ponta do cateter. RESULTADOS: Foram estudados 433 pacientes. As incidências de retenção urinária e náuseas/vômitos foram de 1,3% e 16,6%, respectivamente. Houve colonização em 8,6% dos 280 cateteres examinados. Não houve infecções, lesões nervosas nem repercussões sistêmicas. CONCLUSÕES: O uso pré-operatório de antibióticos e o tipo de agulha utilizado foram fatores de risco para colonização dos cateteres.JUSTIFICATIVA Y OBJETIVOS: La analgesia postoperatoria fue muy estimada en los últimos años. Los catéteres plexulares son una buena opción para la analgesia de calidad con una mínima repercusión sistémica. El presente estudio quiso evaluar la incidencia de efectos colaterales y complicaciones en analgesia postoperatoria con catéteres plexulares, e identificar factores de riesgo para la colonización bacteriana en los catéteres. MÉTODO: Pacientes sometidos a operaciones ortopédicas entre marzo de 2005 y enero del 2007 que recibieron analgesia a través de catéteres de plexo. Se evaluaron la incidencia de los efectos colaterales y las complicaciones con el uso de la técnica. En una parte de los casos, se efectuó el cultivo de la punta del catéter. RESULTADOS: Fueron estudiados 433 pacientes. La incidencia de retención urinaria y n

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

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    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

  19. Manejo conservador de la fístula quilosa postoperatoria con somatostatina: Report of three cases

    OpenAIRE

    NEVEUC,RODRIGO; FERNÁNDEZ R,ROBERTO; BUCHCHOLTZ F,MARTÍN; González V,Marcelo; RODRÍGUEZ T,JUAN C; TRUJILLO L,CRISTIAN; ODDÓ B,DAVID

    2006-01-01

    La fístula quilosa post quirúrgica es una complicación rara pero molesta en la cirugía torácica y abdominal, es en efecto difícil de manejar necesitando en un importante número de casos la reintervención. El abordaje inicial es conservador con dietas bajas en ácidos grasos de cadena media y/o nutrición parenteral total. Ultimamente se ha introducido el uso de la somatostatina, la que aparece como un tratamiento efectivo en el manejo de esta complicación, sugerido por algunos autores como tera...

  20. Bupivacaína-buprenorfina vs. bupivacaína por vía caudal para analgesia postoperatoria en el paciente pediátrico en cirugía ortopédica Bupivacaine-buprenorphine vs. caudal bupivacaine as postoperative analgesia for pediatric patients undergoing orthopedic surgery

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    M. E. Flores Arana

    2011-04-01

    Full Text Available Introducción: el dolor postoperatorio en el niño constituye una entidad especial ya que en el influyen varios factores, por tanto es una experiencia no esperada por el niño y más difícil de tratar. Objetivos: evaluar y comparar la duración y calidad de la analgesia postoperatoria caudal así como la estabilidad hemodinámica y los efectos adversos entre bupivacaína-buprenorfina contra bupivacaína. Material y método: ensayo clínico controlado, prospectivo, longitudinal y comparativo; se estudian 40 pacientes de 1 a 7 años, para cirugía ortopédica bajo bloqueo caudal en el HTO No 21 de Monterrey, Nuevo León, de mayo 2009 a enero 2010. Se asignan en forma aleatoria a dos grupos: grupo A bupivacaína 0,25% 1,4 ml/kg y grupo B se le administrará bupivacaína al 0,25% 1,4 ml/kg adicionada de 1 μg/kg de buprenorfina. La intensidad del dolor postoperatorio se medirá a través del EVA, NIPS Y CRIES a las 2, 4, 6, 12 y 24 horas posteriores. Análisis estadístico: T de Student, U de Mann-Whitney; y prueba de Chi cuadrado. Resultados: el tiempo de administración del primer analgésico posterior a cirugía fue más corto en el grupo A (5,33 vs. 8,46 horas, con una diferencia a favor del grupo B (p Background: postoperative pain in children is a special entity and that the influence various factors, therefore it is an unexpected experience for the child and more difficult to treat. Objective: to evaluate and compare the length and quality of post-operative caudal analgesia and hemodynamic stability and adverse effects between bupivacaine-buprenorphine against bupivacaine. Material and methods: a controlled clinical trial, prospective, longitudinal, comparative study included 40 patients 1-7 years for orthopedic surgery under caudal block in the HTO No 21, of Monterrey, Nuevo Leon, from May 2009 to January 2010. Are assigned at random to two groups: group A 0.25% bupivacaine 1.4 ml/kg, and group B bupivacaine mL/kg 0.25% 1.4 mg/kg of

  1. Morbilidad y mortalidad en conducto ileal y su relación con nutrición parenteral total postoperatoria

    OpenAIRE

    G. González Ávila; H. Rodríguez Ovalle; J. A. Rojas Barrera

    2006-01-01

    Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel....

  2. 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

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    Luiz Eduardo Imbelloni

    2006-12-01

    dos cinco nervos do plexo lombar.JUSTIFICATIVA Y OBJETIVOS: Este estudio evaluó la eficacia de la inyección única de bupivacaína a 0,25% en el compartimiento del psoas o perivascular inguinal a través del estimulador de nervios periféricos para analgesia postoperatoria en pacientes sometidos a intervenciones quirúrgicas ortopédicas. MÉTODO: Cien pacientes recibieron bloqueo del plexo lumbar a través del compartimiento del psoas y fueron comparados con 100 pacientes que recibieron bloqueo del plexo lumbar vía perivascular inguinal, identificados por el estimulador de nervios periféricos con la inyección de 40 mL bupivacaína a 0,25% sin epinefrina. La analgesia en los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fue evaluada a las 4, 8, 12, 16, 20 y 24 horas después del final de la intervención quirúrgica. La intensidad del dolor también fue medida en el mismo período. La cantidad de opioides administrada en el postoperatorio fue anotada. En cinco pacientes de cada grupo, un estudio radiográfico con contraste no iónico se realizó para medir la dispersión de la solución anestésica. RESULTADOS: Los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fueron bloqueados en 92% de los pacientes en el compartimiento del psoas versus 62% en el bloqueo perivascular inguinal. El bloqueo del plexo lumbar redujo la necesidad de opioides y 42% de los pacientes sometidos al bloqueo del compartimiento del psoas y 36% de los pacientes en el bloqueo inguinal no necesitaron analgésico adicional en el postoperatorio. La duración de la analgesia fue de aproximadamente 21 horas con el bloqueo del compartimiento del psoas y 15 horas en el bloqueo perivascular inguinal. CONCLUSIONES: El bloqueo del compartimiento del psoas y perivascular inguinal es una excelente técnica para la analgesia postoperatoria en intervenciones quirúrgicas ortopédicas reduciendo la necesidad de opioides. Ese

  3. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

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    Monica Rossi Rodrigues

    2009-12-01

    con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección de PJC en niños. MÉTODO: Estudio randómico doble ciego, en niños sometidos a la intervención quirúrgica para liberación posteromedial de PJC, ubicadas en cuatro grupos conforme a la técnica anestésica: caudal (ACa; bloqueos isquiático y femoral (IF; bloqueos isquiático y safeno (IS; bloqueo isquiático y anestesia local (IL, asociados a la anestesia general. En las primeras 24 horas, los pacientes recibieron dipirona y paracetamol vía oral y fueron evaluados por un anestesiólogo que no conocía la técnica usada. Conforme a las puntuaciones de la escala CHIPPS (Children's and infants postoperative pain scale, se administraba morfina vía oral (0,19 mg.kg-1 por día. RESULTADOS: Fueron estudiados 118 niños distribuidos en los grupos ACa (30, IF (32, IS (28 IL (28. El tiempo promedio entre el bloqueo y la primera dosis de morfina fue de 6,16 horas en el grupo ACa, 7,05 horas en el IF, 7,58 horas en el IS y 8,18 horas en el IL. El consumo de morfina fue de 0,3 mg.kg-1 por día en los cuatro grupos. No hubo diferencia significativa entre los grupos. CONCLUSIONES: Los bloqueos nerviosos periféricos no promovieron un tiempo más elevado de analgesia, ni tampoco una reducción en el consumo de morfina en las primeras 24 horas, en niños sometidos a la corrección de PJC cuando se les comparó con el bloqueo epidural caudal.BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF is associated with

  4. ANALGESIA EN EL DOLOR CIATICO AGUDO CON LA CAUTERIZACION DEL PUNTO CIATICO AURICULAR

    OpenAIRE

    MATIAS SANCHEZ, MARIA MAGDALENA

    2009-01-01

    LA CIATICA ES NO DE LOS PADECIMIENTOS MAS COMUNES QUE PADECE EL SER HUMANO Y UNA DE LAS CAUSAS QUE PROVOCAN INCAPACIDAD TANTO EN LA VIDA LABORAL COMO COTIDIANA, NO EXISTIENDO EN LA ACTUALIDAD UN MECANISMO QUE TENGA ACEPTACION Y CREDITOS COMPLETOS QUE PUEDAN CONSIDERARSE PREDOMINANTE O APLICABLES EN TODOS LOS PACIENTES QUE SE QUEJAN DE ESTE MAL. EN MEXICO NO SE HAN REALIZADO ESTUDIOS ESTADISTICOS ESPECIFICOS PARA ESTE PADECIMIENTO. CON ESTE ESTUDIO SE COMPROBO LA ANALGESIA EN EL DOLOR CIATI...

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

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    J.R. González-Escalada

    2010-02-01

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

  6. Incidência de depressão respiratória no pós-operatório em pacientes submetidos à analgesia venosa ou peridural com opioides Incidencia de depresión respiratoria en el postoperatorio en pacientes sometidos a la analgesia venosa o epidural con opioides The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids

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    Leonardo Teixeira Domingues Duarte

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A analgesia controlada pelo paciente (PCA, por via venosa ou peridural, é técnica segura e eficaz no tratamento da dor pós-operatória. Todavia, o uso de opioides não é isento de risco, e a depressão respiratória é a complicação mais temida. Os objetivos deste estudo foram descrever a incidência de depressão respiratória associada à analgesia pós-operatória com opioides administrados por via peridural ou venosa e as características dos pacientes que apresentaram a complicação. MÉTODO: Estudo de incidência, retrospectivo, em pacientes operados no Hospital SARAH Brasília entre dezembro de 1999 e dezembro de 2007 e tratados com PCA com opioides por via venosa ou peridural. Foram definidos como casos de depressão respiratória: frequência respiratória JUSTIFICATIVA Y OBJETIVOS: La analgesia controlada por el paciente (PCA, por vía venosa o epidural, es una técnica segura y eficaz en el tratamiento del dolor postoperatorio. Sin embargo, el uso de opioides no está exento de riesgos y la depresión respiratoria es la complicación más temida. Los objetivos de este estudio fueron describir la incidencia de depresión respiratoria asociada a la analgesia postoperatoria con opioides administrados por vía epidural o venosa, y las características de los pacientes que presentaron la complicación. MÉTODO: Estudio de incidencia retrospectiva en pacientes operados en el Hospital SARAH Brasília entre diciembre de 1999 y diciembre de 2007 y tratados con PCA con opioides por vía venosa o epidural. Se definieron como casos de depresión respiratoria, frecuencia respiratoria d" 8 irpm, necesidad del uso de naloxona, o saturación periférica de oxígeno por debajo de un 90%. RESULTADOS: Fueron evaluados 2790 pacientes, de los cuales 635 pacientes recibieron PCA venosa y 2155, analgesia epidural. Se dieron siete casos de depresión respiratoria postoperatoria (incidencia de 0,25%. De ellos, seis pacientes

  7. Morbilidad y mortalidad en conducto ileal y su relación con nutrición parenteral total postoperatoria Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition

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    G. González Ávila

    2006-08-01

    Full Text Available Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel. Sujetos: Ciento catorce pacientes consecutivos tratados con cistectomía radical y conducto ileal entre enero de 2000 a Junio de 2004. Intervenciones: Ochenta y un pacientes recibieron nutrición parenteral total postoperatoria durante un promedio de 9.2 días y 33 controles recibieron solución glucosada 5% + salina 0.9%. Principales resultados y mediciones: Treinta y seis (31.6% pacientes se complicaron y once murieron (9.6%.Las principales complicaciones relacionadas con muerte fueron quirúrgicas. Después de un análisis multivariado de regresión logística, y de acuerdo al riesgo e intervención nutricional se encontró en el grupo con desnutrición grave una reducción importante (RR=0.09, IC95%=0.02-0.33,p=0.008 en la frecuencia de muerte temprana. La dehiscencia de anastomosis en presencia de sepsis abdominal fue el factor predictor más importante de muerte temprana(RR=5.0; IC95%=1.45-17-3; p=0.007. Conclusiones: El grupo sin desnutrición o con desnutrición leve no se beneficia de la nutrición parenteral total postoperatoria.Background: The frequency of complications and early death in patients with hyponutrition and total radical cystectomy with ileal duct is high. The role of artificial nutritional support on short-term outcomes is still controversial. Objective: to determine whether total parenteral nutrition reduces the frequency of complications and death when it is administered during the immediate post-surgical period. Design

  8. Nutrición postoperatoria en pacientes con cáncer de cabeza y cuello Postoperative nutritional support in head and neck cancer patients

    OpenAIRE

    C. Martín Villares; M. E. Fernández Pello; J. San Román Carbajo; M. Tapia Risueño; J. Domínguez Calvo

    2003-01-01

    Los pacientes sometidos a cirugía por cáncer de cabeza y cuello son enfermos con problemas nutricionales especiales por la localización del tumor y las secuelas poscirugía. El objetivo del presente trabajo será el estudio del tipo de nutrición que precisan estos pacientes en el postoperatorio y los problemas asociados. Pacientes y métodos: Se estudian de forma prospectiva 54 pacientes con cáncer de cavidad oral o faringolaringe sometidos a cirugía. Se valora el tipo de alimentación del enferm...

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

    OpenAIRE

    M.J. Mayorga Buiza; F. Caba Barrientos; F. Suárez Cordero; M. Echevarría Moreno

    2010-01-01

    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 mayo...

  10. Nutrición postoperatoria en pacientes con cáncer de cabeza y cuello Postoperative nutritional support in head and neck cancer patients

    Directory of Open Access Journals (Sweden)

    C. Martín Villares

    2003-10-01

    Full Text Available Los pacientes sometidos a cirugía por cáncer de cabeza y cuello son enfermos con problemas nutricionales especiales por la localización del tumor y las secuelas poscirugía. El objetivo del presente trabajo será el estudio del tipo de nutrición que precisan estos pacientes en el postoperatorio y los problemas asociados. Pacientes y métodos: Se estudian de forma prospectiva 54 pacientes con cáncer de cavidad oral o faringolaringe sometidos a cirugía. Se valora el tipo de alimentación del enfermo en el postoperatorio: alimentación por boca, nutrición enteral por sonda nasogástrica, nutrición parenteral. Se estudian las complicaciones posoperatorias surgidas en relación con la alimentación: neumonía por aspiración, fístula faringo-cutánea, inposibilidad para restablecer la alimentación por boca. Resultados: Solo el 7% de los pacientes pudieron realizar alimentación por boca en el postoperatorio, precisando nutrición enteral por sonda nasogástrica el 87% y el 6% nutrición parenteral. El 6% de los pacientes presentaron neumonía por aspiración y el 19% fístula faringocutánea. Al alta, el 98% podían alimentarse por boca -el 18% con suplemento enteral-, mientras que un paciente nunca se pudo retirar la sonda nasogástrica. Conclusiones: 1 el 93% precisa nutrición artificial en el postoperatorio de cáncer de cabeza y cuello; 2 el tipo de nutrición más empleado es la nutrición enteral por sonda nasogástrica (87% siendo poco frecuente la necesidad de nutrición parenteral (6%; 3 el 25% de los pacientes presentan complicaciones en relación con la alimentación (18% faringostoma, 6% neumonía por aspiración; 4 el 98% de los pacientes recupera la capacidad de alimentarse por la boca al alta.Patients who underwent surgery for head and neck malignant neoplasms are problematic because dysphagia, pain and postoperative secuelaes. Nutritional support is necesary in more than 90% of all patients with head and neck cancer. The

  11. Complicaciones neurológicas postoperatorias en pacientes operados de cirugía cardíaca con circulación extracorpórea

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    Alain Moré Duarte

    2015-03-01

    Full Text Available Introducción: La disfunción neurológica durante el postoperatorio de la cirugía cardiovascular, constituye una de las causas principales de invalidez por las posibles secuelas, luego de la instauración de esta complicación.Objetivo: Caracterizar el comportamiento de las complicaciones neurológicas durante el postoperatorio de pacientes operados de cirugía cardiovascular con circulación extracorpórea.Método: Se realizó una investigación descriptiva longitudinal retrospectiva, con 39 pacientes ingresados en la sala de cuidados intensivos quirúrgicos del Cardiocentro “Ernesto Che Guevara” de Santa Clara, Cuba, que presentaron disfunción neurológica en el postoperatorio inmediato; en el período de enero de 2011 a diciembre de 2013.Resultados: Las disfunciones neurológicas fueron más frecuentes en el sexo masculino (74,3 % y el grupo de edad entre 64-74 años. La revascularización miocárdica fue la cirugía de más incidencia. El hábito de fumar está presente en el 51,3 % de los pacientes y el 92,3 % padecían de hipertensión arterial. La mayoría de los pacientes se mantuvieron por más de 120 minutos en circulación extracorpórea, y predominó la complicación neurológica tipo II, fundamentalmente la desorientación en el 35,9 % de los casos.Conclusiones: Predominaron los hombres de edad avanzada, fumadores e hipertensos, sometidos a revascularización miocárdica con circulación extracorpórea prolongada. La desorientación fue la complicación neurológica más frecuente.

  12. Analgesia preemptiva com S(+cetamina e bupivacaína peridural em histerectomia abdominal Analgesia preemptiva con S(+cetamina y bupivacaína peridural en histerectomía abdominal Preemptive analgesia with epidural bupivacaine and S(+ketamine in abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Ferdinand Edson de Castro

    2005-02-01

    utilizadas em histerectomia abdominal.JUSTIFICATIVA Y OBJETIVOS: El presente estudio investiga la capacidad del antagonista del receptor NMDA, S(+cetamina, asociado a la inyección peridural de anestésico local (bupivacaína en promover analgesia preemptiva en pacientes sometidas a histerectomía total abdominal, administrando esa solución antepasadamente a la incisión. MÉTODO: Fueron evaluadas 30 pacientes, distribuidas aleatoriamente en dos grupos de igual tamaño y estudiadas prospectivamente de forma encubierta. Inyección peridural e inserción de catéter fueron realizadas entre los interespacios de L1-L2. En el grupo I (G1, n = 15, las pacientes recibieron por vía peridural, 17 mL de bupivacaína a 0,25% sin vasoconstrictor asociados a 30 mg de S(+cetamina (3 mL treinta minutos antes de la incisión quirúrgica y, después de 30 minutos de la incisión, recibieron 20 mL de solución fisiológica a 0,9%. En el grupo 2 (G2, n = 15, recibieron 20 mL de solución fisiológica por vía peridural, 30 minutos antes de la incisión, fue hecha una administración de 17 mL de bupivacaína a 0,25% asociadas a 30 mg de S(+cetamina (3 mL, treinta minutos después de la incisión. Después de la inyección peridural, se realizó anestesia general con propofol, pancuronio, O2 e isoflurano. Para analgesia post-operatoria fue usada solución peridural en bolus de fentanil asociada a la bupivacaína, con intervalo mínimo de cuatro horas. La suplementación con dipirona solamente era usada si necesario. Se evaluó la intensidad del dolor a través de escala numérica y verbal (al despertar, 6, 12, 18 24 horas después del término de la operación, el tiempo necesario para pedir por la primera vez el analgésico y el consumo total de analgésicos. RESULTADOS: No hubo diferencia significativa entre los grupos con relación al tiempo para pedir analgésicos por la primera vez, al consumo de analgésicos y a los resultados de dolor por las escalas numérica y verbal. CONCLUSIONES: No

  13. Temperatura, Oximetría Cerebral y Disfunción Cognitiva Postoperatoria (DCPO) en pacientes intervenidos de Prótesis Total de Rodilla (PTR) con anestesia intradural. Estudio prospectivo

    OpenAIRE

    Salazar Garcia, Fátima

    2015-01-01

    Introducción: La Disfunción cognitiva postoperatoria (DCPO) tiene una alta incidencia en pacientes de cirugía ortopédica. Durante la anestesia y la cirugía se produce un descenso progresivo de la temperatura. Esta hipotermia tiene efectos deletéreos pero también puede tener un efecto protector cerebral. Nosotros planteamos la hipótesis que la temperatura perioperatoria puede tener un impacto sobre la aparición de DCPO. Por otro lado, la monitorización de la saturación regional cerebral de...

  14. Complicaciones postoperatorias en la herniorrafia ambulatoria con malla: Estudio comparativo de la tasa de infección del sitio operatorio con y sin profilaxis antibiótica

    OpenAIRE

    LEÓN S,JORGE; Acevedo F,Alberto; RIOSECO R,DAVID; VÁSQUEZ V,JORGE; DELLEPIANE,E.U. VERÓNICA

    2011-01-01

    Introducción: El uso de la profilaxis antibiótica en la cirugía hemiaria con malla es controversial. El propósito del presente estudio es establecer la efectividad de la profilaxis antibiótica (PA) en la prevención de la infección del sitio operatorio (ISO) en la herniorrafía con malla efectuada en forma ambulatoria con anestesia local. Material y Método: El estudio observacional analítico se realizó dentro del Programa de Cirugía Ambulatoria del CRS Cordillera, en dos grupos consecutivos de ...

  15. Estudio descriptivo de la analgesia obtenida durante el trabajo de parto con PCA de remifentanilo: modelo británico

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    C. Morales Muñoz

    2014-12-01

    Full Text Available Introducción: la analgesia epidural obstétrica continúa siendo el "gold-standard" para controlar el dolor durante el trabajo de parto, pero en determinadas ocasiones la técnica está contraindicada o la analgesia es incompleta. El remifentanilo es un opioide potente de rápida acción y vida media ultracorta, que se adapta perfectamente a la dinámica del parto. La coordinación entre el comienzo de las contracciones y la administración del fármaco mediante un dispositivo PCA hacen que esta técnica pueda ser considerada de elección para el alivio de dolor durante el parto y no solo como alternativa a la epidural. Objetivo: este estudio pretende valorar la eficacia y seguridad en el parto del remifentanilo administrado por vía intravenosa, así como la satisfacción materna de la analgesia recibida. Materiales y métodos: estudio descriptivo prospectivo basado en el análisis de la recogida de datos realizado por los investigadores durante el parto donde se recoge el dolor durante la dilatación y el expulsivo antes y después de la aplicación de la PCA de remifentanilo, así como las complicaciones y la incidencia de efectos secundarios. Paralelamente se realiza una encuesta de satisfacción materna de la técnica recibida y su vivencia personal. Resultados: se han recogido un total de 32 casos durante el periodo de estudio (6 meses. Todas las pacientes han presentado una reducción de dolor manifestado por una disminución del EVA respecto del dolor basal de 5,9 puntos en los primeros minutos, 4,6 puntos en completa y 3,4 en el expulsivo. No se han registrado complicaciones materno-fetales importantes derivadas de la técnica. La satisfacción materna ha sido alta, volviendo incluso a repetir la técnica en un 90 % de los casos. Conclusiones: la PCA de remifentanilo ha demostrado ser efectiva y segura como analgesia obstétrica. Es por ello que la PCA ha teniendo una amplia aceptación entre matronas, ginecólogos y anestesiólogos en

  16. Eficacia del hierro intravenoso carboximaltosa para la mejoría de la anemia postoperatoria en pacientes de prótesis de rodilla

    OpenAIRE

    Moltó García, Luis

    2014-01-01

    Introducción A pesar del tratamiento de la anemia preoperatoria, el riesgo de anemia postoperatoria permanece en la cirugía mayor y esto puede afectar la tasa de transfusión y el rendimiento físico. El objetivo del estudio fue evaluar la eficacia del hierro carboximaltosa (HCM) intravenoso (iv) como tratamiento de la anemia postoperatoria tras la artroplastia total de rodilla (PTR) y su posible influencia en la rehabilitación. Métodos. Los pacientes de PTR con anemia postoperatoria [hemoglobi...

  17. Sensibilidad postoperatoria tras el cementado en prótesis fija Postoperative sensibility post fixed prosthodontic cementation

    Directory of Open Access Journals (Sweden)

    R Del Castillo Salmerón

    2004-10-01

    Full Text Available De entre las complicaciones postoperatorias en prótesis fija, la sensibilidad ocupa un lugar destacado para algunos autores. Se evaluó la frecuencia de sensibilidad postoperatoria en dos grupos: (1 cementando una prótesis fija sólo con ionómero de vidrio -IV- y (2 añadiendo previamente al cementado con IV un agente desensibilizante. Se puede concluir que la aplicación de un desensibilizante no supuso una mejoría clínica significativa en la sensibilidad postoperatoria.Between the most frequent complications in partial fixed prosthodontics, the postoperative sensitibity occupies an outstanding place for several authors. In this work was evaluated the frequency of postoperative sensitibity in 42 patients with full-coverage restorations were cemented with glass ionomer (group 1 or dentin bonding agent and glass ionomer (group 2. There were not differences between the groups.

  18. The effects of Agaricus sylvaticus fungi dietary supplementation on the metabolism and blood pressure of patients with colorectal cancer during post surgical phase Efectos de la suplementación dietética con hongos Agaricus sylvaticus en el metabolismo y la presión arterial en pacientes con cáncer colorrectal en la fase postoperatoria

    Directory of Open Access Journals (Sweden)

    R. Costa Fortes

    2011-02-01

    , triglicéridos, ácido úrico, urea, creatinina, fosfatasa alcálica, bilirrubina total, directa e indirecta, aspartato aminotransferasa y alanina aminotransferasa, inmunoglobulina A (IgA, G (IgG y M (IgM; proteínas totales y fracciones se realizaron, y midieron los niveles de presión arterial durante el tratamiento. Los resultados fueron analizados con Microsoft Excel 2003 y SPSS 14.0 con una significación de p < 0,05. Resultados: Observado en Agaricus sylvaticus, reducción significativa de la glucosa (p = 0,02, colesterol total (p = 0,01, creatinina (p = 0,05, aspartato aminotransferasa (p = 0,05, alanina aminotransferasa (p = 0,04, IgA (p = 0,0001, IgM (p = 0,02, presión arterial sistólica (p = 0,0001 y la presión arterial diastólica (p = 0,0001; resultados no observados en el grupo placebo. Conclusiones: Los resultados sugieren que la suple-mentación dietética con hongos Agaricus sylvaticus es capaz de ejercer beneficios metabólicos y los parámetros bioquímicos, enzimáticos y la presión arterial de los pacientes con cáncer colorrectal en la fase postoperatoria.

  19. Analgesia preventiva con pregabalina en intervenciones de hernia con malla: Revisión al año Preventive analgesia with pregabalin in mesh hernia repair: Review at 1 year

    Directory of Open Access Journals (Sweden)

    M.P. Acín

    2009-05-01

    Full Text Available Objetivo: La analgesia preventiva consiste en la administración de fármacos para conseguir un estado analgésico previo al trauma quirúrgico que disminuya la respuesta sensitiva periférica y central al dolor, con la cual se intenta interrumpir el círculo inflamacióndolor-hiperalgesia-aumento del estímulo doloroso. Pregabalina es un neuromodulador utilizado en el tratamiento del dolor neuropático; varios trabajos indican que se puede administrar en la prevención del dolor postoperatorio. El objetivo de este trabajo fue realizar un estudio comparativo de dolor postoperatorio en pacientes intervenidos de hernia por cirugía abierta con colocación de malla, tratados con pregabalina o sin ella. Material y métodos: Se realizó un estudio prospectivo, aleatorizado, que incluyó a 140 pacientes intervenidos de hernia inguinal, crural o umbilical con malla, por cirugía abierta, con 112 varones y 28 mujeres. Grupo I: 70 de ellos fueron tratados con pregabalina 75 mg noche durante 3 días antes de la intervención y 75 mg noche durante 12 días después, incluido el día de la intervención. Grupo II: 70 sin pregabalina. No hubo diferencias entre ambos grupos en edad, que estaban comprendidos entre 18-79 años (edad media: 55,47 ± 13,38 años ni tampoco en el grado ASA: entre I-III. La evaluación del dolor se basó en la escala analógica verbal y consumo de pirazolonas. Los controles se realizaron después de 1, 6 y 12 meses de la intervención. Se registraron los efectos adversos, el número de horas de sueño y la mejoría o no en la calidad del sueño. El análisis estadístico se realizó con el test de Kolmogorov-Smirnov del programa Statgraphics. Se consideró significativa una p Objective: Preventive analgesia consists of administrating drugs to achieve an analgesic state that decreases the peripheral and central sensory response to pain prior to surgical injury; thus, the aim is to break the cycle of inflammation

  20. Analgesia preventiva y multimodal con ketamina y dipirona en mastectomía radical por cáncer de mama

    OpenAIRE

    Miladys Justo Hernández; Leticia Fernández Álvarez; Yamila Zayas Nápoles; Alina Pérez Sánchez; Sandra Ramos Rojas

    2015-01-01

    El dolor agudo es frecuente en los pacientes que requieren intervención quirúrgica; su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal y preventiva. Se realizó un estudio longitudinal, prospectivo en 22 pacientes, a los que se les practicó mastectomía radical por cáncer de mama, con el objetivo de describir el uso de la analgesia multimodal y preventiva con ketalar y dipirona en el manejo del dolor posoperatorio de estos pacientes....

  1. Mal posición de tornillos pediculares lumbares que producen radiculalgia mecánica postoperatoria con estimulación neurofisiológica intraoperatoria normal: el valor de la estimulación neurofisiológica del trayecto del tornillo

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    Vicente García González

    2013-12-01

    Full Text Available OBJETIVO: Valorar una exploración neurofisiológica que identifique estos casos intraoperatoriamente y evite la mal posición de tornillos pediculares. MÉTODOS: En 293 pacientes intervenidos de escoliosis por vía posterior con tornillos pediculares y técnica "free hand", se implantaron 6.739 tornillos. De estos, ocho pacientes (2,7%, con edad promedio de 24 años, presentaron dolor radicular lumbar postoperatorio. En la TC postoperatoria se encontraron 10 tornillos lumbares (2L1-3L2-4L3-1L4 con prominencia mínima en la parte inferior del pedículo. Se evaluaron los umbrales de EMG del tornillo y del trayecto. RESULTADOS: En cirugía inicial no se detectaron anomalías en la palpación del trayecto, ni en el control radioscópico, ni alteraciones neurofisiológicas en la estimulación neurofisiológica con t-EMG. Todos presentaron dolor radicular en bipedestación y sedestación que remitía con reposo en cama. Los tornillos fueron retirados quirúrgicamente a los 37 días en promedio (R:4-182. En esta cirugía se repitió la monitorización neurofisiológica y volvió a mostrar valores normales (> 11mA. Tras la retirada de los tornillos, se realizó estimulación del trayecto que mostró en la parte media, umbrales por debajo de los valores normales (3,9-10,7mA. Tras un seguimiento promedio de 4,4 años (R:2,6-6.8, cinco pacientes referían tener molestias radiculares ocasionales y uno tenía déficit motor mínimo en la extremidad afectada. CONCLUSIONES: Se presenta un tipo de mal posicionamiento de tornillo pedicular lumbar que produce radiculalgia en bipedestación-sedestación y que no es detectado con monitorización convencional. La estimulación neurofisiológica del trayecto en la zona media, tras retirada del tornillo pedicular, produjo umbrales bajos de estimulación. Se recomienda estimulación sistemática del trayecto antes de la inserción del tornillo pedicular lumbar.

  2. Analgesia preventiva y multimodal con ketamina y dipirona en mastectomía radical por cáncer de mama

    Directory of Open Access Journals (Sweden)

    Miladys Justo Hernández

    2015-11-01

    Full Text Available El dolor agudo es frecuente en los pacientes que requieren intervención quirúrgica; su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal y preventiva. Se realizó un estudio longitudinal, prospectivo en 22 pacientes, a los que se les practicó mastectomía radical por cáncer de mama, con el objetivo de describir el uso de la analgesia multimodal y preventiva con ketalar y dipirona en el manejo del dolor posoperatorio de estos pacientes. La técnica anestésica utilizada fue total intravenosa, con propofol y fentanyl, dosis convencional. En el postoperatorio se vigiló la aparición de efectos colaterales. Los datos se colocaron en tablas de contingencia, procesados mediante el sistema de cálculos estadísticos que presenta Microsoft Excel. El análisis se realizó fundamentalmente a través de medidas de resúmenes, porcentaje y media aritmética. Se concluyó que la analgesia multimodal preventiva con ketamina y dipirona fue efectiva y segura en todos los casos, a los que se realizó radical de mama. Predominó el grupo de edad entre 46 y 65 años y ASA II. Las variables hemodinámicas y respiratorias se mantuvieron estables en todos los pacientes. No necesitaron analgesia de rescate. La somnolencia se manifestó en 13,6% de los casos.

  3. Morbilidad y mortalidad en conducto ileal y su relación con nutrición parenteral total postoperatoria Morbidity and mortality from ileal duct and its relationship with post-surgical total parenteral nutrition

    OpenAIRE

    G. González Ávila; H. Rodríguez Ovalle; J. A. Rojas Barrera

    2006-01-01

    Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel....

  4. Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical

    OpenAIRE

    Mezzadri,Juan José; Rimoldi,Jaime Jorge

    2010-01-01

    OBJETIVO: determinar la longitud de la raíz C5. MÉTODOS: se estudiaron con resonancia magnética (Signa 1,5 T, cortes axiales de 5 mm de espesura, TR=850, TE=26, FOV=200) las columnas cervicales de 50 pacientes (29 hombres - 21 mujeres) entre 26 y 68 años. Se incluyeron solo casos con cervicalgia y/o cervicobraquialgia. Se midió (en mm) la longitud de las raíces cervicales tercera a séptima, derechas e izquierdas. La comparación de los promedios se realizó a través del análisis de varianza, pa...

  5. Efecto de la osteotomía sagital de mandíbula sobre el cóndilo mandibular: cambios morfológicos, posicionales y su relación con la estabilidad postoperatoria

    OpenAIRE

    2015-01-01

    Estudio prospectivo sobre los cambios posicionales y morfológicos de los cóndilos mandibulares sometidos al procedimiento quirúrgico de la osteotomía sagital de avance mandibular. El grupo de estudio consta de 17 pacientes, 25 cóndilos, sometidos a osteotomía sagital de avance con o sin cirugía maxilar. El grupo control consta de 6 pacientes, 12 cóndilos, sometidos únicamente a cirugía maxilar. Para el registro de los cambios producidos por la cirugía, se utiliza la tomografía computarizada y...

  6. Niveles de vitamina A y zinc en pacientes de cirugía gastroenterológica: Relación con la inflamación y la aparición de complicaciones postoperatorias Vitamin A and zinc levels in gastroenterological surgical patients: Relation with inflammation and postoperative complications

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    L. B. Zago

    2011-12-01

    Full Text Available Introducción: Se acepta que la depleción aún moderada de algunos nutrientes puede afectar la evolución del paciente quirúrgico. Objetivo: Evaluar la influencia de los niveles plasmáticos de retinol y de zinc preoperatorios sobre la evolución postoperatoria; evaluar la influencia de la inflamación sobre los niveles de ambos marcadores. Métodos: Se determinaron los niveles plasmáticos de retinol y zinc en 50 pacientes previo a ser sometidos a cirugías gastroenterológicas programadas. Para caracterizar el estado nutricional global de los pacientes se incluyeron el IMC y el porcentaje de pérdida de peso (%PP previo a la cirugía. Se utilizó la Proteína C Reactiva (PCR como marcador de inflamación. Durante el seguimiento se registraron las complicaciones postoperatorias. El presente análisis se realizó sobre 43 pacientes con información completa. Resultados: Se hallaron valores bajos de retinol (Introduction: It is accepted that even mild nutrient depletion may affect the evolution of the surgical patient. Objective: To evaluate the influence of preoperative levels of plasma retinol and zinc on postoperative evolution of surgical patients; to evaluate the influence of inflammation on both level markers. Methods: Plasma retinol and zinc were determined in 50 patients before programmed gastroenterological surgeries. To detect global malnutrition BMI and weight loss percentage (WL% were included. C-reactive protein (CRP was included as inflammation marker. During follow up postoperative complications were recorded. The present analysis was carried out in 43 patients with complete information. Results: Low retinol values (< 20 μg/dl were founded in 3 cases and low Zn values (< 85 μg/dl in 20 cases, being 9 of them indicative of severe deficiency (< 70 μg/dl. Postoperative complications were recorded in 17 patients; patients with complications presented lower values of plasma Zn (78.4 ± 25.8 vs. 87.8 ± 25.7 μg/dl and retinol (36

  7. Hiperparatiroidismo primario: Evolución postoperatoria a largo plazo

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    Francisco R. Spivacow

    2010-10-01

    Full Text Available Presentamos la evolución postoperatoria a largo plazo de 87 pacientes con hiperparatiroidismo primario. Del total, 78 mujeres y 9 varones, relación: 8.7:1. Edad media 55.3 ± 10.2 años. Antes de la cirugía el 44% presentó litiasis renal, el 70% osteopenia u osteoporosis y un 71.2% tuvo hipercalciuria. Se encontró disminución del filtrado glomerular en el 12.6%. Del total, 72 pacientes presentaron un adenoma único, dos un doble adenoma, dos hiperplasia, cuatro histología normal y en siete no se pudo disponer del resultado. El calcio sérico, el calcio iónico, el fósforo y la parathormona intacta se normalizaron en todos los pacientes postcirugía. La densitometría ósea aumentó un 6.9% en columna lumbar y un 3% en cuello de fémur. Los marcadores del remodelado óseo se normalizaron y persistieron normales a los 23 meses del seguimiento, coincidiendo con la parathormona intacta. Lo mismo sucedió con los valores de 25 OH D. Cuando se compararon pacientes con hipercalciuria inicial vs. aquellos con normocalciuria, no se encontraron diferencias en los valores basales y postcirugía en ambos grupos. En 11 pacientes con filtrado glomerular previo < 60 ml/min, encontramos una parathormona intacta más elevada que el resto y menor densidad mineral ósea. El filtrado glomerular no cambió en forma significativa luego de la cirugía. En conclusión, el hiperparatiroidismo primario operado por cirujanos especializados tiene una excelente evolución a largo plazo, con normalización de todos los parámetros del metabolismo fosfocálcico y del remodelado óseo y mejoría significativa en la densidad mineral ósea. Los efectos adversos son escasos y de resolución espontánea.

  8. 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

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    Neuber Martins Fonseca

    2003-04-01

    perivascular inguinal, llamado de bloqueo 3 en 1, ha sido utilizado para analgesia pós-operatoria. El objetivo de este estudio fue comparar la analgesia pós-operatoria del bloqueo 3 en 1 a la de la morfina subaracnóidea en pacientes sometidos a cirugías ortopédicas en miembro inferior (MI. MÉTODO: Fueron estudiados 40 pacientes escalados para cirugía ortopédica de MI, de ambos sexos, estado físico ASA I y II, con edades entre 15 y 75 años, distribuidos en 2 grupos (M y BPL. Fue realizada anestesia subaracnóidea en todos los pacientes, en L3-L4 ó L4-L5, con 20 mg de bupivacaína isobárica a 0,5%. En el grupo M (n = 20 fue asociado 50 µg de morfina al anestésico local. En el grupo BPL (n = 20 fue realizado el bloqueo 3 en 1 al término de la cirugía, utilizando 200 mg de ropivacaína a 0,5%. Se evaluó la analgesia y la intensidad del dolor a las 4, 8, 12, 14, 16, 20 y 24 horas después del término de la cirugía, el nivel del bloqueo subaracnóideo, el tiempo quirúrgico y las complicaciones. RESULTADOS: La duración de la analgesia en el grupo BPL fue de 13,1 ± 2,47, en cuanto en el grupo M todos los pacientes referían dolor y ausencia de bloqueo motor en el primero instante evaluado (4 horas. Hubo falla del bloqueo de uno de los 3 nervios en 3 pacientes. La incidencia de náusea y prurito fue significativamente mayor en el grupo M. Cuanto a la retención urinaria, no hubo diferencia significante entre los grupos. No hubo depresión respiratoria, hipotensión arterial o bradicardia. La analgesia pós-operatoria fue mas efectiva en el grupo BPL, comparada al grupo M a las 4, 8, 12,14 y 16 horas. A las 20 y 24 horas no hubo diferencia significante entre los grupos.BACKGROUND AND OBJECTIVES: Perivascular Lumbar plexus inguinal block, (3-in-1 block has been used for postoperative analgesia. This study aimed at comparing postoperative analgesia of 3-in-1 block and spinal morphine in patients submitted to lower limb orthopedic surgeries (LL. METHODS: Forty ASA I

  9. Estudio de los efectos térmicos de la sedación postoperatoria tras cirugía cardíaca con circulación extracorpórea: Estudio comparativo entre la sedación intravenosa con propofol versus inhalatoria con sevofluorano

    OpenAIRE

    Arce Ramos, Nuria

    2013-01-01

    Comparamos los efectos térmicos dos tipos de sedación: intravenosa con propofol versus inhalatoria con sevoflurano durante postoperatorio hasta la extubación en pacientes de cirugía cardiaca electiva con circulación extracorpórea. Estudio prospectivo, de cohortes, controlado y aleatorizado, para 100 pacientes adultos. Termometría central-nasofaríngea y cutánea-digital infrarroja fueron múltiples, horarias. Análisis estadístico de los registros (termometría, tiempos sedación-despertar-extubaci...

  10. Niveles de vitamina A y zinc en pacientes de cirugía gastroenterológica: Relación con la inflamación y la aparición de complicaciones postoperatorias Vitamin A and zinc levels in gastroenterological surgical patients: Relation with inflammation and postoperative complications

    OpenAIRE

    L. B. Zago; E. Danguise; C. A. González Infantino; M. E. Río; Callegari, M.

    2011-01-01

    Introducción: Se acepta que la depleción aún moderada de algunos nutrientes puede afectar la evolución del paciente quirúrgico. Objetivo: Evaluar la influencia de los niveles plasmáticos de retinol y de zinc preoperatorios sobre la evolución postoperatoria; evaluar la influencia de la inflamación sobre los niveles de ambos marcadores. Métodos: Se determinaron los niveles plasmáticos de retinol y zinc en 50 pacientes previo a ser sometidos a cirugías gastroenterológicas programadas. Para carac...

  11. Evolução pós-operatória de pacientes com refluxo protético valvar Evolución postoperatoria de pacientes con reflujo protésico valvular Postoperative outcome of patients with prosthetic valve leak

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    Roney Orismar Sampaio

    2009-09-01

    ótesis valvular con los eventos clínicos de los pacientes. OBJETIVO: Comparar la evolución postoperatoria de pacientes con reflujo de prótesis valvular leve/moderado (L/M o severo (S. MÉTODOS: Teniendo en cuenta a los 1.350 pacientes sometidos a la cirugía valvular entre el 1999 y el 2001, se seleccionaron a 185 pacientes con reflujo de prótesis valvular. De ellos, se evaluaron retrospectivamente datos clínicos, laboratoriales y ecocardiográficos de una muestra de 58 pacientes (37 varones con reflujo de prótesis valvular en el pre y/o en el postoperatorio de reemplazo valvular con datos completos en prontuarios, con 36 presentado reflujo L/M versus 22 con reflujo S. RESULTADOS: La incidencia de reoperación fue del 11,1% en el Grupo L/M versus el 22,7% en el Grupo S (odds ratio = 2,35 [IC95% 0,56-9,94]. La Endocarditis fue la causa de reoperación en el 75% de los pacientes del Grupo L/M y en el 60% del Grupo S. Las bioprótesis aórticas fueron las más afectadas por reflujo (el 55,8% en el Grupo L/M y el 57,7% en el Grupo S. Evolucionaron sin reflujo de prótesis valvular en el segundo postoperatorio el 40% de los pacientes con reflujo previo L/M versus el 21,4% de los pacientes con reflujo de prótesis valvular S. No hubo diferencia significantes en las variables laboratoriales. CONCLUSIÓN: 1 Los portadores de reflujo severo tienen mayor probabilidad de reoperación. 2 Endocarditis fue la causa más frecuente de reoperación para cualquier grado de reflujo. 3 El reflujo de prótesis valvular severo es de más difícil resolución completa tras tratamiento quirúrgico.BACKGROUND: Prosthetic valve leak is a possible complication of surgical valve replacement. Although uncommon, its consequences may be serious. Few studies correlate the degree of prosthetic valve leak with clinical events. OBJECTIVE: To compare the postoperative outcome of patients with mild/moderate (Mi/Mo or severe (Sev prosthetic valve leak METHODS: A total of 185 patients with prosthetic valve leak

  12. Evaluación del dolor y adecuación de la analgesia en pacientes en tratamiento con hemodiálisis

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    Raquel Pelayo Alonso

    2015-12-01

    Full Text Available Introducción: El dolor es el síntoma más común en el paciente renal, debido a la comorbilidad asociada, a la técnica dialítica y a un mayor tiempo de permanencia en hemodiálisis. Objetivo: Determinar la prevalencia del dolor intradiálisis y crónico así como la adecuación del tratamiento analgésico en pacientes en programa de hemodiálisis. Metodología: Estudio descriptivo en 33 pacientes sometidos a hemodiálisis en el que se utilizaron diferentes escalas de valoración: Brief Pain Inventory (para determinar el dolor crónico, Escala Visual Analógica (para valorar el dolor intradiálisis y el Pain Management Index (para comprobar la adecuación de la analgesia. Resultados: Presentaron dolor crónico el 57,57% de los pacientes y dolor intradiálisis el 78,8%. En ambos casos, fue de tipo músculo-esquelético, de intensidad leve (3,14 puntos y 3,13 puntos respectivamente y relacionado con un mayor tiempo de permanencia en hemodiálisis. El dolor crónico interfirió con el estado de ánimo, el trabajo habitual y la relación con otras personas. La adecuación del tratamiento fue correcto para el dolor crónico pero no para el dolor intradiálisis. Conclusiones: El dolor es un síntoma frecuente en nuestra muestra. El dolor intradiálisis presenta un manejo farmacológico inadecuado y peor que el dolor crónico.

  13. Estudo retrospectivo das infecções pós-operatórias em cirurgia de coluna: correlação com o número de limpezas cirúrgicas realizadas Estudio retrospectivo de infecciones postoperatorias en cirugía de espina dorsal: correlación con el número de desbridamientos quirúrgicos realizados Retrospective study of post-operative infections in spine surgery: correlation with the number of surgical debridement performed

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    Guilherme Pereira Corrêa Meyer

    2011-01-01

    Full Text Available OBJETIVO: Avaliar as características das infecções pós-operatórias e determinar a resolução das mesmas em relação ao número de limpezas e de agentes infectantes. MÉTODO: Foram avaliados todos os prontuários dos pacientes que evoluíram com infecção pós-operatória durante 30 meses para análise e correlação de diversas variáveis. Nesses 30 meses, 40 pacientes evoluíram com infecção pós-operatória de um total de 410 cirurgias. Foram excluídos os casos de infecção primária da coluna (osteomielite ou espondilodiscite totalizando três casos. Variáveis relacionadas ao paciente, ao procedimento e à evolução foram avaliadas e correlacionadas com as variáveis chaves: número de limpezas cirúrgicas e de agentes infectantes isolados nas culturas. RESULTADOS: A taxa de infecção pós-operatória foi de 9,83%. Foram relacionadas as diversas variáveis estudadas com o número de limpezas cirúrgicas realizadas e não foi possível estabelecer uma relação. No entanto verificou-se que os pacientes com maior número de procedimentos cirúrgicos apresentavam maior taxa de dor pós-operatória. CONCLUSÃO: Pacientes submetidos a um maior número de procedimentos apresentaram mais dor na evolução pós-operatória. Não houve correlação estatisticamente significativa entre o número de limpezas ou de agentes com as demais variáveis. Um maior número de pacientes no estudo pode ser necessário para identificar outras relações.OBJETIVO: Evaluar las características de infecciones postoperatorias y determinar la solución de ellas con relación al número de limpiezas y desbridamientos quirúrgicos, y agentes infecciosos. MÉTODO: Recolectamos, para un período de 30 meses, todos los registros de pacientes que tuvieron infección postoperatoria y varias variables fueron analizadas y correlacionadas. En esos 30 meses, 40 pacientes, de un total de 410 cirugías, tuvieron infección postoperatoria. Excluimos casos de infecci

  14. Analgesia perioperatória com infusão peridural contínua da combinação de morfina e clonidina em crianças submetidas a procedimentos cirúrgicos abdominais Analgesia perioperatoria con infusión peridural continua de la combinación de morfina y clonidina en niños sometidos a procedimientos quirúrgicos abdominales Perioperative analgesia with continuous epidural infusion of morphine combined with clonidine in children undergoing abdominal surgeries

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    Jyrson Guilherme Klamt

    2007-12-01

    y seis niños destinados a operaciones intra-abdominales fueron ubicados aleatoriamente en de los grupos. Los de los grupos recibieron, por vía peridural, bolus de morfina (8 µg.kg-1 y de clonidina (0,8 µg.kg-1 antes del inicio de la intervención quirúrgica, seguidos de infusión continua de clonidina (0,12 µg.kg-1.h-1 más morfina (1,2 µg.kg-1.h-1 en el Grupo I y el doble de esa dosis en el Grupo II, durante 24 horas. Fueron medidas las concentraciones inspiratorias de isoflurano durante la operación y el número de dosis (1 mg.kg-1 de tramadol durante 24 horas en el postoperatorio. RESULTADOS: Las concentraciones de isoflurano fueron significativamente menores con relación a los valores observados antes de la incisión quirúrgica después 60 y 90 minutos en los grupos II y I, respectivamente, sin embargo no hubo diferencia entre los de los grupos. El consumo de tramadol fue significativamente menor en el grupo 2, siendo que 7 (53,8% no necesitaron analgesia de rescate, sin embargo fueron observadas mayor sedación e hipotensión arterial. No fue observada depresión respiratoria en los de los grupos. CONCLUSIÓN: La infusión peridural de la combinación de bajas dosis de clonidina y morfina promovieron reducción de la necesidad de isoflurano en el período intraoperatorio y analgesia postoperatoria de buena calidad.BACKGROUND AND OBJECTIVES: The present study was developed to evaluate the analgesic effects of the epidural administration of a combination of morphine and clonidine, whose efficacy has been demonstrated in adults, on the consumption of isoflurane and postoperative consumption of analgesics in children. METHODS: Twenty-six children scheduled for intra-abdominal surgeries were randomly divided in two groups. Both groups received an epidural bolus of morphine (8 µg.kg-1 and clonidine (0.8 µg.kg-1 before the surgery, followed by the continuous infusion of clonidine (0.12 µg.kg-1.h-1 plus morphine (1.2 µg.kg-1.h-1 in Group I, and twice

  15. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA?

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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.

  16. Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial Analgesia pos-operatoria con bloqueo bilateral del nervio pudendo con bupivacaína S75:R25 a 0,25%: estudio piloto en hemorroidectomia bajo régimen ambulatorial Bilateral pudendal nerves block for postoperative analgesia with 0.25% S75:R25 bupivacaine: pilot study on outpatient hemorrhoidectomy

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    Luiz Eduardo Imbelloni

    2005-12-01

    permitirão demonstrar se esta técnica deve ser a primeira opção para analgesia em hemorroidectomias. A permanência de anestesia perineal por 20,21 horas deverá induzir novos trabalhos com o bloqueio dos nervos pudendos orientado por estimulador para o ato cirúrgico.JUSTIFICATIVA Y OBJETIVOS: La hemorroidectomia puede ser realizada bajo varias técnicas anestésicas y en régimen ambulatorial. El dolor pos-operatorio es intenso y puede atrasar el retorno para el hogar. El objetivo de este estudio fue evaluar las ventajas y la realización del bloqueo bilateral de los nervios pudendos para analgesia pos-operatoria en hemorroidectomias. MÉTODO: El bloqueo bilateral de los nervios pudendos con bupivacaína S75:R25 a 0,25% fue realizado con estimulador de nervios en 35 pacientes sometidos a la hemorroidectomia bajo raquianestesia. Fueron evaluadas intensidad del dolor, duración de la analgesia, analgesia de demanda y eventuales complicaciones relacionadas a la técnica. Los datos fueron evaluados a las 6, 12, 18, 24 y 30 horas después del término de la intervención quirúrgica. RESULTADOS: En todos los pacientes, fue logrado éxito con la estimulación de ambos los nervios pudendos. En ningún momento de la evaluación ocurrió dolor intenso. Hasta 12 horas después del bloqueo, todos los pacientes presentaron anestesia en la región perineal; con 18 horas, 17 pacientes y 24 horas, 10 pacientes A analgesia pos-operatoria fue óptima en 18 pacientes; satisfactoria, en cinco pacientes; e insatisfactoria, en siete pacientes. La duración media de la analgesia fue de 23,77 horas. No ocurrieron alteraciones de la presión arterial, de la frecuencia cardiaca, ni fueron observados náuseas o vómitos. Todos los pacientes tuvieron micción espontánea. Ninguna complicación local o sistémica fue relacionada al anestésico local. Veintisiete pacientes clasificaron de excelente la técnica de analgesia y apenas tres pacientes del sexo masculino quedaron satisfechos

  17. Descompensación distal postoperatoria (D.D.P. en curvas lenke 1a tratadas con tornillos pediculares: una revisión de 63 casos Descompensação distal pós-operatória (DDP em curvaturas lenke 1a tratadas com parafusos pediculares: análise de 63 casos Postoperative distal decompensation (PDD in lenke 1a curvatures treated with pedicular screws: analysis of 63 cases

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    Norberto Ventura

    2012-06-01

    Full Text Available OBJETIVO: Identificar los factores de riesgo de descompensación distal postoperatoria (D.D.P. y definir una estrategia quirúrgica segura en curvas tipo Lenke 1A tratadas con tornillos pediculares. MÉTODO: Estudio radiológico retrospectivo de 63 pacientes con escoliosis Lenke 1A, con un seguimiento mínimo de un año. Se evaluó, edad, sexo, grados Cobb, signo de Risser, relación de la vértebra distal instrumentada (V.D.I. con la vértebra distal de la curva (V.D., vértebra estable (V.E. y con la vértebra, cuya distancia a la línea central vertical al sacro (L.V.S. era superior a 10 mm "distancia vertebral" (D.V.. RESULTADOS: 8 casos (12,7% desarrollaron D.D.P. El signo de Risser fue 0 en 2 pacientes (25% y I en 2 pacientes (25%. Relación de V.D.I. con V.D.: 4 pacientes (50% mismo nivel (V.D. +0, 4 pacientes (50% un nivel caudal (V.D. (+1; relación V.D.I. con V.E.: 5 pacientes (62,5% 2 niveles cefálicos (V.E -2, 3 pacientes (37,5% 1 nivel cefálico (V. E.-1; relación V.D.I. con D.V.: 5 pacientes (62,5% un nivel cefálico D.V. (-1, 3 pacientes mismo nivel (D.V.+ 0. CONCLUSIONES: Riesgo de descompensación distal postoperatoria: V.D.I. mismo nivel V.D. (V.D. + 0, 2 niveles cefálicos V.E. (V.E.-2, 1 nivel cefálico D.V. (D.V. -1. Estrategia quirúrgica curvas Lenke 1A: V.D.I: 1/2 niveles caudales a V.D. (V.D. +1/+2, un nivel cefálico a V.E. (V.E -1, mismo nivel D.V. (D.V. +0.OBJETIVO: Identificar os fatores de risco de descompensação distal pós-operatória (DDP e definir estratégia cirúrgica de segurança em curvaturas de Lenke 1A, tratadas com parafusos pediculares. MÉTODO: Estudo radiológico retrospectivo de 63 pacientes com escoliose Lenke 1A, com acompanhamento mínimo de um ano. Os parâmetros avaliados foram idade, sexo, graus do ângulo de Cobb, sinal de Risser, relação da vértebra distal instrumentada (VDI com a vértebra distal da curvatura (VD, com a vértebra estável (VE e com a vértebra cuja distância da linha

  18. Bloqueio peridural sacral: avaliação da duração da analgesia com o uso associado de lidocaína, fentanil e clonidina Bloqueo peridural sacral: evaluación de la duración de la analgesia con el uso asociado de lidocaína, fentanil y clonidina Epidural caudal block: evaluation of length of analgesia with the association of lidocaine, fentanyl and clonidine

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    Carlos Alberto de Souza Martins

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A associação de diferentes substâncias aos anestésicos locais é feita com o objetivo de melhorar a qualidade do bloqueio e prolongar a duração da analgesia. O objetivo deste trabalho foi comparar a eficácia da associação de clonidina, clonidina e fentanil e do fentanil à lidocaína, no tempo de analgesia pós-operatória. MÉTODO: O estudo envolveu 64 pacientes com idade igual ou superior a 23 anos, estado físico I ou II (ASA, escalados para cirurgia proctológica orificial, submetidos à anestesia peridural sacral. Os pacientes foram distribuídos em 4 grupos de 16: grupo I (lidocaína isolada, grupo II (lidocaína e fentanil, grupo III (lidocaína, fentanil e clonidina e grupo IV (lidocaína e clonidina. Foram comparadas as características dos bloqueios sensitivo e motor. RESULTADOS: Não houve diferença entre a latência, bem como no nível máximo de bloqueio entre os grupos. A ausência de bloqueio motor foi o resultado mais freqüente, encontrado em cerca de 64% dos pacientes. O intervalo de analgesia foi diferente entre os grupos, sendo mais significativo no grupo III. CONCLUSÕES: O uso da clonidina, associada ou não ao fentanil, prolongou o tempo de analgesia pós-operatória na anestesia peridural sacral com lidocaína.JUSTIFICATIVA Y OBJETIVOS: La asociación de diferentes substancias a los anestésicos locales es hecha con el objetivo de mejorar la cualidad del bloqueo y prolongar la duración de la analgesia. El objetivo de este trabajo fue comparar la eficacia de la asociación de clonidina, clonidina y fentanil y de fentanil a la lidocaína, en el tiempo de analgesia pós-operatoria. MÉTODO: El estudio envolvió 64 pacientes con edad igual o superior a 23 años, estado físico I ó II (ASA, escalados para cirugía proctológica orificial, sometidos a anestesia peridural sacral. Los pacientes fueron distribuidos en 4 grupos de 16: grupo I (lidocaína aislada, grupo II (lidocaína y

  19. 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

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    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

  20. Estudo comparativo da eficácia analgésica pós-operatória de 20, 30 ou 40 mL de ropivacaína no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20, 30 o 40 mL de ropivacaína en el bloqueo de plexo braquial por la vía posterior A comparative study on the postoperative analgesic efficacy of 20, 30, or 40 mL of ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2007-10-01

    fue determinar cuál volumen de anestésico local en el bloqueo de plexo braquial por la vía posterior propicia analgesia postoperatoria para esas operaciones de manera más eficiente. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por vía posterior fueron divididos aleatoriamente en tres grupos de 30. Grupo 1 - volumen de 20 mL; Grupo 2 - volumen de 30 mL; Grupo 3 - volumen de 40 mL. En todos los grupos, el anestésico usado fue la ropivacaína a 0,375%. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó secundando una escala numérica verbal (ENV en las primeras 24 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor promedio,tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. En el grupo de 20 mL hubo un mayor consumo de analgésicos no opioides después de la 12ª hora de postoperatorio. En los grupos de 30 y 40 mL la extensión del bloqueo fue significativamente mayor. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve analgesia eficaz para intervenciones quirúrgicas en el hombro. Los tres diferentes volúmenes estudiados promovieron analgesia similar. La mayor extensión del bloqueo con volúmenes mayores no se tradujo en una mejor analgesia.BACKGROUND AND OBJECTIVES: Arthroscopic surgeries of the shoulder are accompanied by severe postoperative pain. Among the analgesic techniques, brachial plexus block offers the best results. The objective of this study was to determine which volume of local anesthetic in the posterior brachial plexus block offers more adequate analgesia for those procedures. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided in three groups of 30 patients: Group 1 – volume of 20 mL; Groups 2 – volume of 30 m

  1. Complicaciones postoperatorias tempranas de la colporrafia anterior por técnica tradicional versus técnica de sitio específico

    OpenAIRE

    García Riaño, Diego Armando; Aragón Mendoza, Rafael

    2012-01-01

    El prolapso del piso pélvico es una entidad frecuente, especialmente en pacientes postmenopáusicas y en su gran mayoría requiere tratamiento quirúrgico. En este estudio comparamos la aparición de complicaciones postoperatorias tempranas entre la colporrafia anterior con técnica clásica (TC) versus la colporrafia anterior con técnica de sitio especifico (CSE). Se realizó un estudio observacional analítico, retrospectivo, de dos cohortes de pacientes que requirieron colporrafia anterior entre a...

  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

    diferença entre os grupos. CONCLUSÕES: O fentanil ou o sufentanil contínuos em bolus acionados pelo paciente, por via peridural, nas doses utilizadas neste estudo, apresentaram excelente analgesia pós-operatória. No entanto, o sufentanil apresentou efeitos colaterais mais intensos que o fentanil.JUSTIFICATIVA Y OBJETIVOS: Los opioides han sido utilizados por vía peridural asociados o no a anestésicos locales para analgesia pós-operatoria de forma continua y/o en bolus controlado por el paciente. El objetivo de este estudio fue comparar la analgesia pós-operatoria entre el fentanil y sufentanil en infusión continua y en bolus por vía peridural, en pacientes sometidos a la reconstrucción de ligamento de la rodilla. MÉTODO: Participaron del estudio 70 pacientes con edad entre 16 y 47 anos, estado físico ASA I y II, divididos aleatoriamente en dos grupos: Grupo F (fentanil y Grupo S (sufentanil. Todos los pacientes fueron sometidos a anestesia peridural con bupivacaína a 0,5% (100 mg con epinefrina 1:200.000 asociada a fentanil (100 mg. Al final de la cirugía, los pacientes recibieron fentanil (Grupo F o sufentanil (Grupo S por vía peridural en régimen de infusión continua más bolus liberados por el paciente. En el Grupo F fue utilizada solución fisiológica (85 ml conteniendo fentanil 500 µg (10 ml y bupivacaína (5 ml a 0,5%. En el Grupo S fue utilizada solución fisiológica (92 ml conteniendo sufentanil 150 µg (3 ml y bupivacaína (5 ml a 0,5%. Para los dos grupos la bomba de infusión fue programada inicialmente en 5 ml.h-1, con dosis de 2 ml en bolus liberado por el paciente en un intervalo de 15 minutos. Fueron comparados los siguientes parámetros: dolor, número de bolus accionados, consumo de opioides, bloqueo motor, sedación y efectos colaterales. RESULTADOS: No hubo diferencia significativa entre los grupos cuanto la calidad de la analgesia, siendo la mayoría de buena calidad (EAV 0 a 2. Hubo diferencia significativa cuanto al número de

  3. Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1% no bloqueio de plexo braquial pela via posterior Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1% en el bloqueo de plexo braquial por la vía posterior Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1% ropivacaine in posterior brachial plexus block

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    Marcos Guilherme Cunha Cruvinel

    2008-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO: Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5%; Grupo 2: 20 mL de ropivacaína a 0,75%; Grupo 3: 20 mL de ropivacaína a 1%. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV nas primeiras 48 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.JUSTIFICATIVA Y OBJETIVOS: Las intervenciones quirúrgicas por vía artroscópica en el hombro se relacionan con el dolor postoperatorio de gran intensidad. Entre las técnicas de analgesia, el bloqueo del plexo braquial es la que ofrece los mejores resultados. El objetivo de este estudio fue determinar cuál concentración de anestésico local en el bloqueo de plexo braquial por la vía posterior, propicia analgesia postoperatoria más prolongada para esas operaciones. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por la v

  4. Avulsión del plexo braquial traumático no controlado con remifentalino: Papel de la analgesia epidural cervical Traumatic brachial plexus root avulsion unresponsive to remifentanyl role cervical epidural analgesia

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    M. Cortiñas

    2007-04-01

    Full Text Available Presentamos el caso de una paciente que sufrió accidente de tráfico con avulsión del plexo braquial izquierdo, y que presentaba dolor muy intenso (escala visual analógica 8 de características neuropáticas en la fase aguda postraumática. Dosis altas de remifentanilo fueron inefectivas para control del cuadro álgico, el cual se trato con éxito con una infusión de ropivacaína a través de catéter epidural cervical (C5-6. El dolor es controlado en fase crónica (escala visual analógica 2 con agentes específicos contra dolor neuropático (gabapentina, amitriptilina, clonacepam y tramadol.We presented you a patient who suffered a left brachial plexus avulsión with hard neuropatic pain in the posttraumatic acute phase (visual analogue scale 8. High-dose remifentanil infusión was uneffective in controlling pain, which was further ameliorated by ropivacaine infused through a cervical (C5-6 epidural catheter. At discharge pain remained controlled (visual analogue scale 2 with specific treatment against neuropathic pain (gabapentin, amytriptiline, clonacepam, and tramadol.

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

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    P. Mesa Suárez

    2015-04-01

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

  6. 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

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    Daniel Espada Lahoz

    2003-09-01

    melhorou a qualidade do bloqueio quanto à motilidade do músculo reto medial e diminuiu a necessidade de analgésicos no pós-operatório.JUSTIFICATIVA Y OBJETIVOS: La anestesia locorregional para cirugías oftalmológicas ofrece ventajas, como: mínimas alteraciones fisiológicas, anestesia completa, bloqueo de los reflejos oculares, pequeña incidencia de náuseas y vómitos, menor tiempo de recuperación y analgesia pos-operatoria. La preocupación constante con la calidad del bloqueo, así como la abordaje de la analgesia pos-operatoria debe quedar bajo la responsabilidad del anestesiologista. El objetivo de este estudio fue evaluar si el fentanil contribuye en la calidad del bloqueo extraconal y en la analgesia pos-operatoria de facectomias con implantación de lente intra-ocular. MÉTODO: Se estudió la asociación del fentanil y bupivacaína a 0,75% en la calidad del bloqueo ocular y en la analgesia pos-operatoria en 164 pacientes sometidos a facectomia con implantación de lente intra-ocular (técnica extracapsular, de ambos sexos con homogeneidad de parámetros antropométricos, ojo operado, clasificación del estado físico (ASA e índice de riesgo cardíaco de Goldman. Los pacientes fueron distribuidos en dos grupos (82 pacientes en cada grupo por sorteo de forma aleatoria, con y sin fentanil. Se evaluó la calidad del bloqueo por: aparecimiento de dolor en el per-operatorio, manutención de movimentación de los párpados o del globo ocular, persistencia del reflejo de Bell, número de bloqueos realizados para la obtención de condiciones quirúrgicas y evaluación del bloqueo por el cirujano. La analgesia pos-operatoria fue evaluada por la necesidad de complementación analgésica por el paciente. RESULTADOS: Fentanil asociado a la solución anestésica en el bloqueo extraconal aumentó significativamente el bloqueo del músculo recto medial (con fentanil - 17,1%, sin fentanil - 32,9% y diminuyó el consumo de analgésicos en el período pos-operatorio (uso

  7. SEDACIÓN Y ANALGESIA CON BOLOS DE XILAZINA Y MORFINA EN INFUSIÓN CONTINUA EN UNA YEGUA CRIOLLA COLOMBIANA SOMETIDA A OVARIOECTOMÍA EN ESTACIÓN

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    D. A. Zuluaga

    2012-01-01

    Full Text Available En el acto quirúrgico la anestesia es un proceso que siempre conlleva riesgos. Un procedimiento común en equinos es realizar cirugías en estación para disminuir el riesgo de la anestesia general. Para los procedimientos anestésicos en estación en equinos se han utilizado las combinaciones de bolos de xilazina y anestesia local; sin embargo, la analgesia irregular y la marcada ataxia son complicaciones frecuentes. En el presente caso clínico se evaluó un protocolo de bolos de xilazina 0,6 mg/kg I.V. y morfina en infusión I.V. continua a 30 µg/kg/hora, con aplicación de anestesia local para la extraccción de un tumor de células de la granulosa en una yegua. Durante el procedimiento quirúrgico se observó una buena analgesia, sedación moderada y ataxia leve, sin alteraciones cardiovasculares o respiratorias, lo que favoreció el procedimiento quirúrgico; solamente se observó un corto periodo de amotilidad intestinal el cual fue superado espontáneamente. La yegua se recuperó totalmente del procedimiento quirúrgico y presentó evidencia de estro en dos ocasiones dentro del año siguiente a la intervención. Los procedimeintos anestésico y quirúrgico empleados en esta yegua fueron apropiados y la llevaron a su normalidad reproductiva.

  8. Analgesia intra-articular com morfina, bupivacaína ou fentanil após operação de joelho por videoartroscopia Analgesia intra-articular con morfina, bupivacaína o fentanil después de operación de rodilla por videoartroscopia Intra-articular analgesia with morphine, bupivacaine or fentanyl after knee video-arthroscopy surgery

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    Rogério Helcias de Souza

    2002-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O uso de métodos que promovam analgesia para dor do joelho sem prejudicar a função motora tem sido bastante pesquisado. O objetivo do presente estudo foi comparar o efeito analgésico da morfina, da bupivacaína e do fentanil, com a solução fisiológica, injetada por via intra-articular após operação de joelho por videoartroscopia. MÉTODO: Sessenta pacientes foram divididos de forma aleatória, em quatro grupos: GI (n=15 - 10 ml de solução fisiológica; GII (n = 15 - 2 mg de morfina diluídos para 10 ml de solução fisiológica; GIII (n = 15 - 10 ml de bupivacaína a 0,25%; GIV (n = 15 - 100 µg de fentanil diluídos para 10 ml de solução fisiológica, injetados ao término da operação. Todos os pacientes foram submetidos à anestesia subaracnóidea com 15 mg de bupivacaína hiperbárica. A intensidade da dor foi avaliada pela escala analógica visual (imediatamente após o término da operação e após 6, 12, 18 e 24 horas, bem como a necessidade de complementação analgésica (dipirona 1 g por via venosa. Foram anotados os possíveis efeitos colaterais. RESULTADOS: Não houve diferença significativa na intensidade da dor entre os grupos, na quase totalidade dos tempos estudados. Houve diferença estatística até seis horas, quando o grupo fentanil apresentou intensidade da dor significativamente menor. O grupo morfina necessitou de maior número de complementações com dipirona. Os efeitos colaterais foram mínimos, sem significância estatística. CONCLUSÕES: Não houve diferença significativa entre a analgesia promovida pelas soluções estudadas na maioria dos tempos investigados.JUSTIFICATIVA Y OBJETIVOS: El uso de métodos que promuevan analgesia para el dolor de rodilla sin perjudicar la función motora ha sido bastante pesquisado. El objetivo del presente estudio fue comparar el efecto analgésico de la morfina, de la bupivacaína y del fentanil, con la solución fisiológica, inyectada

  9. ¿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

  10. 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

    los pacientes mostró un alto grado de satisfacción, un 16% de los pacientes satisfacción moderada y un 0,2% poca satisfacción. Conclusión: nuestro estudio demuestra la viabilidad y seguridad de la utilización de infusores elastoméricos endovenosos como método de analgesia postoperatoria, que permiten controlar los casos de dolor moderado a severo en procedimientos aplicados a la cirugía ambulatoria. Sin embargo se necesitan más estudios comparativos con técnicas analgésicas convencionales, así como con diferentes regímenes de infusión.Introduction: moderate to severe postoperative pain is still a problem in outpatient surgery, since it causes patient flow problems and delays the discharge of patients, being one of the major causes of re-hospitalization and hence a relevant quality indicator of these Units. The use of home invasive analgesic techniques, in all their regimes, can be effective for the management of postoperative pain in these surgical procedures and allow them to be included in outpatient surgery programs. Objectives: the aim of our study was to determine the feasibility and safety of the use of elastomeric continuous perfusion pumps for the administration of home continuous endovenous analgesia, as well as to assess analgesic effectiveness and degree of satisfaction of patients undergoing outpatient surgerys. Material and methods: we conducted a simple retrospective study in 463 patients. After the surgical procedure was performed under multimodal analgesia, two differents elastomeric endovenous pumps (dexketoprofeno pump or metamizol pump were used. Pain intensity by means of a visual analog scale and a plain oral scale, the need for supplemental analgesics. At home (24 hours after the surgical operation, the Home Care Unit checked side effects, sleep disorders, pain intensity, need of rescue analgesia and degree of satisfaction. Results: 69% of the patients report absence or slight pain 24 h after the surgical operation, just 16 out of

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

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    Nilton Bezerra do Vale

    2006-10-01

    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.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  12. Postoperative radiotherapy-induced morbidity in rectal cancer Morbilidad de la radioterapia postoperatoria en el cáncer de recto

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    M. Garay Burdeos

    2004-11-01

    Full Text Available Objectives: we analyzed long-term morbidity and bowel function alteration after postoperative radiotherapy for rectal cancer following resection with anastomosis. Patients and methods: thirty-seven patients who underwent surgery with intention to cure and a minimal follow-up period of 3 years were included. These patients were divided into two groups: in the first group, 14 patients received postoperative chemo-radiotherapy, 5-fluorouracil plus folinic acid, and 45 Gy plus 5 Gy boost. In the second group, there were 23 patients regarded as controls. We designed a questionnaire about their bowel function and analyzed the morbidity detected in their follow-up. Results: the group that was treated with postoperative chemo-radiotherapy had more daily bowel movements (p = 0.03 and night-time movements (p = 0.04; incontinence (69.2 versus 17.4% in the control group; p = 0.002, and perianal skin irritation (p = 0.04 versus the control group. Although without meaningful differences, the group under treatment wore a pad more often, had more defecatory urgency, could distinguish worse gas from stool, and needed more frequently antidiarrheal measures. Major complications were present in 28.6% of the under-treatment group: three intestinal resections were performed due to actinic stenosis; one patient had a residual stercoral fistula; another had several occlusive crises solved with medical treatment. Conclusions: postoperative chemo-radiotherapy had a high morbidity rate, which determined a significant alteration in quality of life. Accuracy in indication is therefore necessary, as well as a consideration of other alternatives for treatment, such as preoperative chemo-radiotherapy and total mesorectal excision.Objetivos: analizar la morbilidad y alteración del funcionalismo rectal a largo plazo de la radioterapia postoperatoria tras resección con anastomosis en el cáncer de recto. Material y métodos: se incluyen 37 pacientes intervenidos con intenci

  13. 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

  14. Implicación de la glía en la prevención de la hiperalgesia postoperatoria y la sensibilización latente al dolor postquirúrgico en el ratón

    OpenAIRE

    Romero Alejo, Elizabeth

    2014-01-01

    El dolor agudo postoperatorio (DAP) afecta hasta un 60% de los pacientes sometidos a cirugía a pesar de recibir tratamiento farmacológico; éste puede convertirse en crónico en aproximadamente 15-60%, siendo la intensidad del DAP un factor de riesgo importante. En el modelo de dolor postincisional en el ratón, que reproduce aproximadamente los eventos del perioperatorio en humanos, la cirugía (incisión) induce hiperalgesia postoperatoria (HPO) con una duración de hasta 4 días. El día 21, tras ...

  15. 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.

  16. Factores asociados a infecciones postoperatorias en histerectomía vaginal. Hospital Nacional Arzobispo Loayza 2015

    OpenAIRE

    Florián Castillo, Richard Fredy

    2015-01-01

    Identifica los factores asociados a infecciones postoperatorias en histerectomías vaginales electivas en el periodo de enero a junio del 2015 en el Hospital Nacional Arzobispo Loayza. Métodos de investigación: se realizó un estudio observacional analítico cohorte retrospectivo, que incluyó 79 pacientes, pertenecientes al Servicio de Ginecología del Hospital Nacional Arzobispo Loayza. Para el análisis estadístico se calculó el Odds Ratio y el análisis multivariado de regresión logística. ...

  17. Estudio Observacional sobre el dolor Postoperatorio leve o moderado: Evaluación del tratamiento con Paracetamol IV. Estudio EOPEP Observational study about postoperative mild and moderate pain: Evaluation of treatment with intravenous paracetamol. EOPEP study

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    L. M. Torres

    2008-05-01

    Full Text Available Objetivos. Valorar la eficacia y seguridad de la analgesia postoperatoria con paracetamol intravenoso (P-iv. Pacientes y Métodos. Estudio prospectivo, multicéntrico observacional de pacientes sometidos a cirugía de dolor postoperatorio (DPO leve y moderado que recibieron 4 dosis de P-iv 1 g /4-6h, solo o asociado con otros analgésicos. Se valoró el grado de dolor mediante la escala analógica visual, la afectación de la actividad, los efectos indeseables y la satisfacción del paciente. Periodo de estudio. 24 horas postoperatorias. Se aplicaron tests paramétricos o no paramétricos, o un modelo de regresión logística. Resultados. 725 pacientes evaluables, 56% con DPO previsiblemente leve y 43.3% DPO moderado. La EVA disminuyó significativamente en cada una de las valoraciones sucesivas (pObjective. Te evalúate the efficacy and safety of post-surgery analgesia with intravenous paracetamol (P-iv. Patient and Methods. Prospective, multicentre-observational study in patients who had surgery associated to mild or modérate postoperative pain (POP that received 4 doses of P-iv 1 g /4-6h, alone or associated with other analgesics. The degree of pain by the visual analogue scale, effect on the activity, undesirable effects and patient satisfaction were recorded. Period of study: 24 hrs post-surgery. Statistics. Parametric or non-parametric, or a model of regression analysis. Results. 725 patient enrolled, 56% with mild POP and 43,3% modérate POP. EVA decreased significantly through the successive evaluations (p<0,001, but remained below 30. 46,3% received only P-iv as analgesic. Metamizol was the most frequently associated analgesic, followed by opiates. Higher levéis of EVA were correlated with: administration of associated analgesics, more interference with the activity, more nauseas and vomiting and smaller degree of satisfaction (p<0.05. The type of surgery was correlated with greater valúes of EVA. No undesirable effects caused by P

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

    OpenAIRE

    P. Mesa Suárez; V. Aceña Fabián; M.J. González Forte; F. Neira Reina; D. Portilla Huerta

    2015-01-01

    La enfermedad renal crónica (ERC) es una situación clínica cada vez más prevalente. Esto se debe en gran medida al aumento de la esperanza de vida y al incremento de la incidencia de la diabetes mellitus (DM) y la hipertensión arterial (HTA). Estos pacientes requieren un manejo cuidadoso de la analgesia postoperatoria. El fentanilo es un fármaco cuya farmacocinética encaja en el manejo del dolor en la ERC. Sus diferentes presentaciones comerciales permiten elaborar estrategias adecuadas para ...

  19. EFECTOS DE LA BETAMETASONA EN LA FORMACIÓN DE ADHERENCIAS PERITONEALES POSTOPERATORIAS EN RATAS

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    Luis Alfredo Hernández Villarroel

    2014-01-01

    Full Text Available Objetivos: Evaluar los Efectos de la Betametasona, en la Formación de adherencias peritoneales postoperatorias en modelo animal de la ONU. Metodología: A 10 Ratas hembrasSprague-Dawley se les practico Cirugía formadora de adherencias peritoneales y were Distribuidas de forma aleatoria en 2 Grupos, Qué grupo ONU recibio dosisintraperitoneal Única de Betametasona, y El Otro Como grupo control. Resultados: Los animales sacrificados were y evaluados a los 15 Días, differences observandoestadísticamente significativas Entre los Grupos en Cuanto Al Numero (p = 0,013, severidad (p = 0,049, Grado de Inflamación (= 0027, de proliferaciones vasculares(p = 0,007 y fibrosis (p = 0,040 de las adherencias peritoneales. Conclusión: Este Estudio demostro la del que gestion de Betametasona Disminuye la Formaciónde adherencias peritoneales postoperatorias y, del tanto del por, la ONU Tiene efecto preventivo de las MismaPalabras Clave: adherencias tisulares, betametasona, Inflamación.

  20. Factores pronósticos de complicaciones postoperatorias en el trasplante hepático Prognostic factors associated with postoperative complications in liver transplantation

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    A. Rodríguez-Ariza

    2008-03-01

    Full Text Available Objetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo. Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias. Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas. Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO.Objectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity

  1. Hiperparatiroidismo primario: Evolución postoperatoria a largo plazo Primary hyperparathyrodism: Postoperative long-term evolution

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    Francisco R. Spivacow

    2010-10-01

    Full Text Available Presentamos la evolución postoperatoria a largo plazo de 87 pacientes con hiperparatiroidismo primario. Del total, 78 mujeres y 9 varones, relación: 8.7:1. Edad media 55.3 ± 10.2 años. Antes de la cirugía el 44% presentó litiasis renal, el 70% osteopenia u osteoporosis y un 71.2% tuvo hipercalciuria. Se encontró disminución del filtrado glomerular en el 12.6%. Del total, 72 pacientes presentaron un adenoma único, dos un doble adenoma, dos hiperplasia, cuatro histología normal y en siete no se pudo disponer del resultado. El calcio sérico, el calcio iónico, el fósforo y la parathormona intacta se normalizaron en todos los pacientes postcirugía. La densitometría ósea aumentó un 6.9% en columna lumbar y un 3% en cuello de fémur. Los marcadores del remodelado óseo se normalizaron y persistieron normales a los 23 meses del seguimiento, coincidiendo con la parathormona intacta. Lo mismo sucedió con los valores de 25 OH D. Cuando se compararon pacientes con hipercalciuria inicial vs. aquellos con normocalciuria, no se encontraron diferencias en los valores basales y postcirugía en ambos grupos. En 11 pacientes con filtrado glomerular previo The long-term postoperative outcome of 87 patients with primary hyperparathyrodism is here presented. Of the total 78 were females and 9 males, ratio: 8.7:1. Mean age 55.3 ± 10.2 years. Before surgery, 44% had kidney stones, 70% had osteopenia or osteoporosis and 71.2% had hypercalciuria. Decrease renal glomerular filtration was found in 12.6%. Of the total, 72 patients had a single adenoma, two double adenoma, two hyperplasia, four had normal histology and seven could not dispose of the result. Serum calcium, ionized calcium, phosphorus and intact parathyroid hormone were normalized in all post surgery patients. Bone mineral density increased by 6.9% in lumbar spine and 3% in femoral neck. Markers of bone remodeling were normalized and persisted normal 23 months of follow-up, coinciding with

  2. CENTRAL MECHANISMS OF ACUPUNCTURE ANALGESIA

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    Eman S. Mansour

    2015-12-01

    Full Text Available Background: Acupuncture is an component of traditional Chinese medicine (TCM that has been used for three thousand years to treat diseases and relieve pain. Pain is found to be the most common reason for people to use acupuncture. Due to recent scientific findings, acupuncture treatment has been accepted worldwide. Numerous trials have been conducted especially in analgesia. The mechanisms of acupuncture analgesia has been widely investigated, however, the underlying mechanism still not clear. This article summarizes the central mechanisms of acupuncture analgesia and reviews recent studies on the topic. Method: We have focused on examining the recent literature on acupuncture analgesia. The central mechanisms of acupuncture analgesia and reviews recent studies on the topic. We focused on the studies related to central mechanisms of acupuncture analgesia from these aspects: (neurophysiology, neurochemistry and neuroanatomy. Result: The result revealed that acupuncture act on various parts of the central nervous system, including the spinal cord, brain stem, cerebral ganglia and cerebral cortex to alleviate pain. The central mechanisms underlying the effects of acupuncture include neurohumors and neurotransmitters, which are involved in analgesia. At spinal level, Spinal opioids, glutamate, norepinephrine and serotonin are the key elements acupuncture-induced analgesia. At brain level, Endogenous opioid peptides, limbic system play essential roles in mediating the analgesia. Conclusion: Acupuncture is an effective approach to pain management. There is good evidence in both experimental and clinical research that supports acupuncture efficacy in management of chronic pain through central nervous system. Acupuncture should be strongly used as a part of pain management plans. This work helps in improving our understanding of the scientific basis underlying acupuncture analgesia.

  3. Meningitis tras anestesia y analgesia espinal

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    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

  4. Evaluación de protocolos de sedación y analgesia con xilazina y dos tasas de infusión continua de morfina en caballos en estación sometidos a castración vía laparascópica

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    JD Ruiz

    2015-01-01

    Full Text Available El objetivo de este estudio fue evaluar la utilización de infusión continua de morfina a dos dosis distintas en cuanto a los niveles de sedación y analgesia en castración laparoscópica en caballos. Se utilizaron 14 caballos criollos colombianos, entre tres y seis años, y peso de 239 a 369 kg clínicamente sanos. A los animales se les administró xilazina (0,6 mg/kg IV, morfina (0,05 mg/kg IV y se asignaron al azar a una infusión continua de morfina (20 o 30 mcg/kg/hora I.V para posteriormente realizar transección de arteria y vena testicular mediante laparoscopia en estación por el flanco. Se evaluaron el grado de ataxia, sedación y analgesia, así como la motilidad gastrointestinal por auscultación y ecografía. Durante los procedimientos anestésicos y quirúrgicos los animales de ambos protocolos presentaron buena estabilidad cardiaca y respiratoria y todos los pacientes tuvieron una sedación de leve a moderada. La ataxia se presentó como moderada al inicio de la cirugía y durante procedimiento anestésico (luego del bolo de xilazina y al final de la cirugía los animales presentaron un grado de ataxia leve a moderado. Alrededor del 93% de los animales tuvieron grados de analgesia de leves a moderadas a los estímulos quirúrgicos dolorosos principalmente el abordaje quirúrgico por el flanco y la ligadura y corte del paquete neurovascular testicular. La motilidad intestinal se disminuyó durante el procedimiento anestésico, pero todos los animales recuperaron totalmente la motilidad intestinal a las seis horas postcirugía. Los procedimientos anestésicos y quirúrgicos fueron apropiados para cirugía abdominal por laparoscopia en equino, con buena estabilidad cardiovascular y respiratoria y sin complicaciones gastrointestinales posteriores a la intervención.

  5. Influencia de la analgesia epidural sobre la incidencia de taquiarritmias en el postoperatorio de la cirugía pulmonar Influence of epidural analgesia on the incidence of tachyarrhythmia during pulmonary surgery postoperative

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    A. Gutiérrez-Guillén

    2004-02-01

    Full Text Available Objetivos: Valorar la influencia del uso de analgesia epidural torácica (AET intra y postoperatoria sobre la presentación de taquiarritmias en el postoperatorio de las resecciones pulmonares. Material y métodos: Se han analizado, de forma retrospectiva, los cursos postoperatorios de 200 pacientes consecutivos intervenidos de resecciones pulmonares mayores (lobectomías, bilobectomías y neumonectomías en nuestro hospital durante el periodo comprendido entre octubre de 1998 y junio de 2002. En este tiempo se ha introducido progresivamente en nuestro Servicio la AET como parte de la técnica anestésica en cirugía pulmonar. Se ha analizado la influencia del empleo de AET en la presentación de episodios de taquiarritmia supraventricular en las primeras 48 horas de postoperatorio. Resultados: Se empleó AET para el manejo anestésico y control del dolor postoperatorio en el 49,5% de los casos (99/200. No existen diferencias significativas entre los grupos de pacientes con y sin AET en cuanto a edad, sexo, riesgo ASA, duración de la intervención y tipo de resecciones practicadas. Presentaron crisis de taquiarritmia el 9,5% de los pacientes (19/200, tratándose, en todos los casos, de fibrilación auricular paroxística. Entre los pacientes que no recibieron AET la tasa de arritmias fue del 13,86% (14/101, mientras que en aquellos en los que se empleó AET como parte de la técnica anestésica y durante el postoperatorio, dicha tasa fue del 5,05% (5/99, siendo dicha diferencia estadísticamente significativa (p=0,034. Conclusiones: El empleo de AET como parte de la técnica anestésica y para el manejo del dolor postoperatorio en cirugía de resección pulmonar parece ejercer un efecto protector en cuanto al desarrollo de fibrilación auricular en el postoperatorio inmediato. Se discuten las posibles causas de este efecto.Objectives: To assess the impact of intra- and post-operative thoracic epidural analgesia (TEA on the incidence of tachy

  6. Prevalencia de dolor en un hospital con unidad de dolor agudo y unidad de dolor crónico: el paso siguiente... analgesia traslacional Prevalence of pain in a hospital with acute and chronic pain units: the next step... translational analgesia

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    J.L. Aguilar

    2009-05-01

    Full Text Available La existencia de unidades de dolor agudo y crónico en el hospital no garantiza que la prevalencia de dolor en el centro y en su ámbito de influencia en asistencia primaria sea mínima. Son necesarias una serie de acciones ulteriores de "traslación" para conseguir un impacto real en ese fenómeno. En este estudio presentamos un corte de prevalencia de dolor en el Hospital Son Llàtzer de Palma de Mallorca. El Servicio de Anestesiología dispone de Unidad de Dolor Crónico y Agudo, realiza formación continuada/investigación intra y extrahospitalaria en dolor en el ámbito médico/enfermera. A pesar de ello la prevalencia de dolor de intensidad en la escala visual analógica (EVA > 6 es de casi un 25% de la población hospitalaria estudiada. Más de un 30% (33-36% de pacientes relataba dolor de moderado a insoportable. Además, parece manifiesto que el tratamiento de dolor a demanda ("rescate" administrado por DUE u orden médica los días festivos, en que hay menor número de profesionales en el centro, es significativamente peor que en los días laborables. En día festivo un 4,56% describe una EVA de 10. Debemos seguir buscando acciones estratégicas para conseguir impactar en la prevalencia de dolor en nuestro medio. Entre ellas se propone la creación de un protocolo analgésico por defecto, gradual por intensidad y origen del dolor, y de prescripción facilitada.Acute and chronic pain units in hospitals do not guarantee a low prevalence of pain, either in the center or in its area of influence in primary care. The goal is to obtain "translational" analgesia in order to decrease the impact of pain. The present study reports data on the prevalence of pain in our institution (Hospital Son Llatzer, Palma de Mallorca, Spain. The Anesthesia Department has Chronic and Acute Pain Units, with continuing education and intra- and extra-hospital research into pain performed by physicians and nurses. Nevertheless, the prevalence of pain intensity > 6

  7. Remifentanil em analgesia para o trabalho de parto Remifentanil en analgesia para el trabajo de parto Remifentanil as analgesia for labor

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    Eliane C S Soares

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As técnicas neuroaxiais representam atualmente os métodos mais efetivos para controle da dor durante o trabalho de parto e a analgesia peridural utilizando soluções anestésicas ultradiluídas é considerada o padrão ouro, promovendo alívio adequado da dor com mínimos efeitos colaterais. Em algumas situações, no entanto, o emprego dessas técnicas é limitado pela existência de contraindicações maternas ou obstáculos estruturais e materiais. Nestes casos, as opções alternativas ainda são precárias e escassas, oferecendo resultados pouco otimistas e de eficácia questionável. CONTEÚDO: Este artigo apresenta, com base em uma revisão da literatura, as informações disponíveis relacionadas ao emprego do remifentanil como técnica alternativa para a analgesia de parto discutindo aspectos farmacocinéticos, farmacodinâmicos, eficácia analgésica, satisfação materna e efeitos colaterais maternos e fetais. CONCLUSÕES: Os dados iniciais apontam o remifentanil como uma opção promissora a ser empregada nas situações em que a gestante não quer ou não pode receber a analgesia neuroaxial.JUSTIFICATIVA Y OBJETIVOS: Las técnicas neuroaxiales representan actualmente los métodos más efectivos para el control del dolor durante el trabajo de parto, y la analgesia epidural utilizando soluciones anestésicas ultradiluidas se considera el estándar oro, promoviendo el alivio correcto del dolor con los mínimos efectos colaterales. En algunas situaciones, sin embargo, el uso de esas técnicas queda limitado por la existencia de contraindicaciones maternas u obstáculos estructurales y materiales. En esos casos, las alternativas todavía son precarias y escasas, ofreciendo resultados poco optimistas y de una eficacia cuestionable. CONTENIDO: Con base en una revisión de la literatura, este artículo muestra que las informaciones disponibles relacionadas a lo empleo de lo remifetanil como técnica alternativa

  8. Reabilitação funcional e analgesia com uso de toxina botulínica A na síndrome dolorosa regional complexa tipo I do membro superior: relato de casos Rehabilitación funcional y analgesia con uso de toxina botulínica A en el síndrome doloroso regional compleja tipo I del miembro superior: relato de casos Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports

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    Gabriela Rocha Lauretti

    2005-04-01

    acometido. Se relatan dos casos de SDRC donde la aplicación de toxina botulínica-A como fármaco coadyuvante contribuyó en la recuperación funcional motora del miembro acometido. RELATO DE LOS CASOS: Dos pacientes portadoras de SDRC tipo I fueron inicialmente evaluadas para control del dolor en miembro superior derecho. Ambas presentaban incapacidad para abrir la mano y dolor por la escala analógica numérica (EAN de 10 en reposo o cuando la mano o los dedos eran pasivamente manejados. Se inició secuencia de 5 bloqueos, del ganglio estrellado ipsilateral a intervalos semanales, con clonidina y lidocaína. Simultáneamente, durante la realización del tercer bloqueo del ganglio estrellado, fue administrado 75 UI de toxina botulínica A en los músculos flexores de las falanges y de la articulación del puño. Una semana después de aplicación de la toxina botulínica A, las pacientes presentaban relajamiento de las falanges y del puño, relataban facilidad para la ejecución de la fisioterapia pasiva y el dolor clasificado fue como 2 (EAN a la manipulación pasiva. Al término de la realización de la secuencia de bloqueos del ganglio estrellado, las pacientes fueron sometidas a 3 sesiones semanales de administración por vía venosa regional de clonidina, lidocaína y parecoxib. Después de 8 meses de evaluación las pacientes presentaron 70% y 80% de recuperación motora y funcional del miembro acometido. CONCLUSIONES: La aplicación por vía muscular de toxina botulínica A resultó en mejora del movimiento del miembro acometido, analgesia auxiliando en su recuperación funcional.BACKGROUND AND OBJECTIVES: Functional inability of the affected limb is often added to alodynia and hyperalgesia in Complex Regional Pain Syndrome (CRPS type I. Two CRPS cases are reported in which botulinum toxin A as coadjuvant drug has contributed to motor and functional recovery of the affected limb. CASE REPORTS: Two CRPS type I patients were initially evaluated for upper limb pain

  9. Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms

    OpenAIRE

    MªB. Gómez Sánchez; N. V. García Talavera Espín; T. Monedero Saiz; C. Sánchez Álvarez; A. I. Zomeño Ros; M. Nicolás Hernández; M.ª J. Gómez Ramos; P. Parra Baños; F. M. González Valverde

    2011-01-01

    Objetivos: La enfermedad oncológica se acompaña de un grado importante de desnutrición que se asocia con elevadas tasas de morbi-mortalidad postoperatoria. El propósito de este estudio fue evaluar la efectividad de un programa de apoyo nutricional perioperatorio de cara a reducir complicaciones postoperatorias, estancias hospitalarias y mortalidad entre pacientes sometidos a cirugía oncológica del tracto digestivo superior. Métodos: Estudio prospectivo aleatorizado sobre una muestra de pacien...

  10. 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

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

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    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 interm

  12. Placebo analgesia: understanding the mechanisms.

    Science.gov (United States)

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo analgesic effects. Distinct psychological traits can modulate expectations of analgesia, which facilitate brain pain control mechanisms involved in pain reduction. Many studies have highlighted the importance and clinical relevance of these responses. Gaining deeper understanding of these pain modulatory mechanisms has important implications for personalizing patient pain management.

  13. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-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......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  14. 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

    OpenAIRE

    Calvo, M.; Gilsanz, F; Palacio, F.; I. Fornet; N. Arce

    2005-01-01

    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 suj...

  15. Pharmacogenomic considerations in opioid analgesia

    Directory of Open Access Journals (Sweden)

    Vuilleumier PH

    2012-08-01

    Full Text Available Pascal H Vuilleumier,1 Ulrike M Stamer,1 Ruth Landau21Klinik für Anästhesiologie und Schmerztherapie, Inselspital Universität Bern, Switzerland; 2Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USAAbstract: Translating pharmacogenetics to clinical practice has been particularly challenging in the context of pain, due to the complexity of this multifaceted phenotype and the overall subjective nature of pain perception and response to analgesia. Overall, numerous genes involved with the pharmacokinetics and dynamics of opioids response are candidate genes in the context of opioid analgesia. The clinical relevance of CYP2D6 genotyping to predict analgesic outcomes is still relatively unknown; the two extremes in CYP2D6 genotype (ultrarapid and poor metabolism seem to predict pain response and/or adverse effects. Overall, the level of evidence linking genetic variability (CYP2D6 and CYP3A4 to oxycodone response and phenotype (altered biotransformation of oxycodone into oxymorphone and overall clearance of oxycodone and oxymorphone is strong; however, there has been no randomized clinical trial on the benefits of genetic testing prior to oxycodone therapy. On the other hand, predicting the analgesic response to morphine based on pharmacogenetic testing is more complex; though there was hope that simple genetic testing would allow tailoring morphine doses to provide optimal analgesia, this is unlikely to occur. A variety of polymorphisms clearly influence pain perception and behavior in response to pain. However, the response to analgesics also differs depending on the pain modality and the potential for repeated noxious stimuli, the opioid prescribed, and even its route of administration.Keywords: pain perception, opioid analgesia, genetic variation, pharmacogenetics

  16. Placebo analgesia: understanding the mechanisms

    OpenAIRE

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

  17. Hallazgos ecográficos en la proctalgia espontánea y postoperatoria Ultrasound findings in spontaneous and postoperative anal pain

    Directory of Open Access Journals (Sweden)

    I. Pascual

    2008-12-01

    Full Text Available Objetivo: valorar la utilidad de la ecografía endoanal como prueba de imagen para identificar la causa del dolor anal en los pacientes que presentan proctalgia idiopática o dolor postoperatorio y analizar cuáles son sus causas más frecuentes. Métodos: se realiza un estudio descriptivo de los hallazgos encontrados en las ecografías endoanales de pacientes con dolor anal en los últimos seis años. Todas las ecografías se llevaron a cabo con un ecógrafo B&K (Cheetah 2003, B&K Medical, Gentofte, Denmark con sonda endoanal de 7 MHz. Resultados: se estudiaron noventa y cinco casos de proctalgia mediante ecografía endoanal. Sesenta y siete correspondieron a pacientes con una cirugía previa perineal o pélvica tras la cual comenzó el dolor anal: 48 habían sido intervenidos de fisura anal, 12 de hemorroidectomía, 4 de episiotomía, 2 de fístula y 1 de prostatectomía. El hallazgo más frecuente tras la cirugía de fisura anal fue la presencia de una esfinterotomía incompleta. Entre los veintiocho pacientes sin cirugía previa, el 57,14% presentaba hipertrofia del esfínter anal interno como única alteración ecográfica. Conclusiones: los pacientes con proctalgia espontánea y postoperatoria pueden ser estudiados mediante ecografía endoanal ya que el uso de la sonda no impide completar la exploración. Con esta prueba se encontró una causa del dolor en el 81,93% de los casos. La hipertrofia del esfínter anal interno aislada es el hallazgo ecográfico más frecuente asociado a proctalgia espontánea.Objective: to assess the use of endoanal ultrasounds to identify anal pain etiology in patients with either spontaneous or postoperative pain, and to review the most frequent causes. Methods: a descriptive study of ultrasound findings in patients with anal pain during the last six years was performed. All ultrasound scans were performed using a B&K Diagnostic Ultrasound System (Cheetah 2003, B&K Medical, Gentofte, Denmark with a 7-MHz

  18. Analgesia regional em cuidados intensivos

    Directory of Open Access Journals (Sweden)

    Luísa Guedes

    2012-10-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A analgesia regional desempenha um papel importante na abordagem multimodal da dor no doente crítico e permite amenizar o desconforto do doente e reduzir os estresses fisiológico e psicológico associados. Ao diminuir as doses de opioides sistêmicos, reduz alguns dos seus efeitos colaterais, como a síndrome de abstinência, possíveis alterações psicológicas e disfunção gastrintestinal. Apesar desses benefícios, seu uso é controverso, uma vez que os doentes em unidades de cuidados intensivos apresentam frequentemente contraindicações, como coagulopatia, instabilidade hemodinâmica e dificuldade na avaliação neurológica e na execução da técnica regional. CONTEÚDO: Os autores apresentam uma revisão sobre analgesia regional em cuidados intensivos, com foco nas principais vantagens e limitações de seu uso no doente crítico, e descrevem as técnicas regionais mais usadas e a sua aplicabilidade nesse contexto.

  19. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

    Directory of Open Access Journals (Sweden)

    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

  20. Partial reinforcement, extinction, and placebo analgesia.

    Science.gov (United States)

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

    2014-06-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electrocutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) under the guise of an analgesic trial. The participants were randomly allocated to different conditioning schedules, namely continuous reinforcement (CRF), partial reinforcement (PRF), or control (no conditioning). Conditioning was achieved by surreptitiously reducing pain intensity during training when the placebo was activated compared with when it was inactive. For the CRF group, the placebo was always followed by a surreptitious reduction in pain during training. For the PRF group, the placebo was followed by a reduction in pain stimulation on 62.5% of trials only. In the test phase, pain stimulation was equivalent across placebo and no placebo trials. Both CRF and PRF produced placebo analgesia, with the magnitude of initial analgesia being larger after CRF. However, although the placebo analgesia established under CRF extinguished during test phase, the placebo analgesia established under PRF did not. These findings indicate that PRF can induce placebo analgesia and that these effects are more resistant to extinction than those established via CRF. PRF may therefore reflect a novel way of enhancing clinical outcomes via the placebo effect.

  1. 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.

  2. [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.

  3. Control radiografico postoperatorio de la instrumentacion con tornillos pediculares toracicos en la escoliosis idiopática del adolescente

    OpenAIRE

    2013-01-01

    OBJETIVO: Evaluar la eficacia intraoperatoria y postoperatoria de la radiografía en la colocación del tornillo pedícular dorsal y su relación con la tomografía computada (CT). MÉTODOS: Se evaluaron 36 pacientes con escoliosis idiopática del adolescente (EIA). Tres observadores clasifican colocación de los tornillos con radiografia . Estas respuestas se compararon con la tomografía computada. RESULTADOS: Se evaluaron un total de 280 tornillos pediculares. La evaluación interobservador fue de 0...

  4. 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....

  5. 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

  6. 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

  7. Hypno-analgesia and acupuncture analgesia: a neurophysiological reality?

    Science.gov (United States)

    Saletu, B; Saletu, M; Brown, M; Stern, J; Sletten, I; Ulett, G

    1975-01-01

    The effects of hypnosis, acupuncture and analgesic drugs on the subjective experience of pain and on objective neurophysiological parameters were investigated. Pain was produced by brief electric stimuli on the wrist. Pain challengers were: hypnosis (induced by two different video tapes), acupuncture (at specific and unspecific loci, with and without electrical stimulation of the needles), morphine and ketamine. Evaluation of clinical parameters included the subjective experience of pain intensity, blood pressure, puls, temperature, psychosomatic symptoms and side effects. Neurophysiological parameters consisted of the quantitatively analyzed EEG and somatosensory evlked potential (SEP). Pain was significantly reduced by hypnosis, morphine and ketamine, but not during the control seesion. Of the four acupuncture techniques, only electro-acupuncture at specific loci significantly decreased pain. The EEG changes during hypnosis were dependent on the wording of the suggestion and were characterized by an increase of slow and a decrease of fast waves. Acupuncture induced just the opposite changes, which were most significant when needles were inserted at traditional specific sites and stimulated electrically. The evoked potential findings suggested that ketamine attenuates pain in the thalamo-cortical pathways, while hypnosis, acupuncture and morphine induce analgesia at the later CNS stage of stimulus processing. Finally some clinical-neurophysiological correlations were explored.

  8. 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

  9. Resolving the Brainstem Contributions to Attentional Analgesia

    Science.gov (United States)

    Brooks, Jonathan C.W.; Davies, Wendy-Elizabeth

    2017-01-01

    Previous human imaging studies manipulating attention or expectancy have identified the periaqueductal gray (PAG) as a key brainstem structure implicated in endogenous analgesia. However, animal studies indicate that PAG analgesia is mediated largely via caudal brainstem structures, such as the rostral ventromedial medulla (RVM) and locus coeruleus (LC). To identify their involvement in endogenous analgesia, we used brainstem optimized, whole-brain imaging to record responses to concurrent thermal stimulation (left forearm) and visual attention tasks of titrated difficulty in 20 healthy subjects. The PAG, LC, and RVM were anatomically discriminated using a probabilistic atlas. Pain ratings disclosed the anticipated analgesic interaction between task difficulty and pain intensity (p pain intensity. Intersubject analgesia scores correlated to activity within a distinct region of the RVM alone. These results identify distinct roles for a brainstem triumvirate in attentional analgesia: with the PAG activated by attentional load; specific RVM regions showing pronociceptive and antinociceptive processes (in line with previous animal studies); and the LC showing lateralized activity during conflicting attentional demands. SIGNIFICANCE STATEMENT Attention modulates pain intensity, and human studies have identified roles for a network of forebrain structures plus the periaqueductal gray (PAG). Animal data indicate that the PAG acts via caudal brainstem structures to control nociception. We investigated this issue within an attentional analgesia paradigm with brainstem-optimized fMRI and analysis using a probabilistic brainstem atlas. We find pain intensity encoding in several forebrain structures, including the insula and attentional activation of the PAG. Discrete regions of the rostral ventromedial medulla bidirectionally influence pain perception, and locus coeruleus activity mirrors the interaction between attention and nociception. This approach has enabled the

  10. 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

  11. 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...

  12. 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.

  13. 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

    abiertas con incisión subcostal, recibieron bloqueo intercostal (Grupo IC, n=30 o bloqueo interpleural (Grupo IP, n=30, ambos con 100 mg de bupivacaína 0,5% con adrenalina, para analgesia pós-operatoria. Fueron evaluados los tiempos de analgesia y las quejas relatadas por los pacientes. RESULTADOS: La calidad de la analgesia fue considerada buena para ambas técnicas. La duración media de analgesia fue de 505 minutos en el grupo IP y 620 minutos en el grupo IC, no habiendo diferencia estadística entre ellos. Náuseas, vómitos y dolor abdominal leve fueron las quejas pós-operatorias más frecuentes. No se constató cualquier complicación pós-operatoria asociada exclusivamente a los bloqueos, así como no fue evidenciado ningún caso de pneumotórax. CONCLUSIONES: Se concluye que las técnicas promovieron analgesia satisfactoria después de colecistectomia, siendo que el bloqueo interpleural presentó mayor facilidad de ejecución.BACKGROUND AND OBJECTIVES: Postoperative analgesia is a wish of all surgical patients and has been used by most anesthesiologists. In addition to opioids, local anesthetic agents have been employed for peripheral and central blocks. The purpose of this study was to evaluate and to compare intercostal and interpleural blocks for post-cholecystectomy analgesia. METHODS: Sixty patients undergoing open cholecystectomy with subcostal incision, received either intercostal block (Group IC, n = 30 or interpleural block (Group IP, n = 30, for postoperative analgesia, both with 0.5% bupivacaine (100 mg with epinephrine. Analgesia duration and patients’ complaints were evaluated. RESULTS: Analgesia was considered satisfactory for both groups. Mean analgesia duration was 505 minutes for Group IP and 620 minutes for Group IC, with no statistical significant difference. Nausea, vomiting and mild abdominal pain were the most frequent postoperative complaints. There was no postoperative complication related to blockade and no pneumothorax was detected

  14. Bupivacaine versus lidocaine analgesia for neonatal circumcision

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    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  15. 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.

  16. Longitud de las raíces cervicales en resonancia magnética: relación con la parálisis postoperatoria de la quinta raíz cervical Medida do comprimento das raízes cervicais pela ressonância magnética: relação com a paralisia pós-operatória e a quinta raiz cervical Cervical nerve root length in magnetic resonance imaging: its relationship with postoperative fifth root palsy

    Directory of Open Access Journals (Sweden)

    Juan José Mezzadri

    2010-03-01

    Full Text Available OBJETIVO: determinar la longitud de la raíz C5. MÉTODOS: se estudiaron con resonancia magnética (Signa 1,5 T, cortes axiales de 5 mm de espesura, TR=850, TE=26, FOV=200 las columnas cervicales de 50 pacientes (29 hombres - 21 mujeres entre 26 y 68 años. Se incluyeron solo casos con cervicalgia y/o cervicobraquialgia. Se midió (en mm la longitud de las raíces cervicales tercera a séptima, derechas e izquierdas. La comparación de los promedios se realizó a través del análisis de varianza, para un nivel de significación α=0,05 con IC de 95%. Las comparaciones post-hoc se hicieron empleando el test de Bonferroni. RESULTADOS: se observó que el lado (derecho o izquierdo y el sexo (varón o mujer no tuvieron incidencia estadísticamente significativa en el valor de la longitud de las raíces (p>0,05. La raíz C5 tuvo un tamaño significativamente diferente (pOBJETIVO: determinar o comprimento da raiz C5. MÉTODOS: as colunas cervicais de 50 pacientes (29 homens - 21 mulheres, com idades entre 26 e 68 anos foram analisadas com ressonância magnética (Signa 1,5 T, cortes axiais de 5 mm de espessura, TR=850, TE=26, FOV=200. Foram incluídos casos com dor cervical e/ou cervicobraquial. O comprimento das raízes C3 a C7, à direita e esquerda, foi medido. A comparação das médias foi realizada com uma análise de variância para um nível de significação α = 0,05 com IC de 95%. As comparações post-hoc foram feitas com o teste de Bonferroni. RESULTADOS: foi observado que o lado (direito ou esquerdo e o sexo (homem ou mulher não tiveram incidência estatística significante em relação ao valor do comprimento das raízes. A raiz C5 evidenciou um tamanho significativamente diferente (pOBJECTIVE: to determine the length of the C5 root. METHODS: the cervical spines of 50 patients (29 male and 21 female, between 26 and 68 years old, were studied with magnetic resonance imaging (Signa 1.5 T, axial images with 5 mm thickness, TR=850, TE=26

  17. Variaciones hematológicas postoperatorias en dermolipectomía Postoperative hematological variations in dermolipectomy

    Directory of Open Access Journals (Sweden)

    W. Giustozzi

    2010-06-01

    Full Text Available La tétrada deformante de la pared abdominal está constituida por la obesidad, la distensión abdominal, la gravidez y la diástasis muscular. Nos planteamos como objetivo de nuestro trabajo el demostrar la variación que sufren el hematocrito y la hemoglobina con relación al porcentaje del peso corporal total que representan los colgajos dermograsos extirpados en una dermolipectomía abdominal, tomando como parámetro los valores obtenidos a las 24 horas de la cirugía y a los 7 días de postoperatorio. Diseñamos un estudio prospectivo observacional en el que analizamos 93 pacientes operados entre el 1 de agosto del 2007 y el 31 de diciembre de 2008. Las variables analizadas fueron las modificaciones sufridas por el hematocrito y la hemoglobina en relación al tanto por ciento de peso corporal total que representan los colgajos extirpados. El promedio de descenso del hematocrito a las 24 horas de la intervención fue del 6,19 % y el de la hemoglobina a las 24 horas de la intervención fue de1,9 gr/l; los valores a los 7 días de postoperatorio fueron de 3,84% y 1,25 gr/l respectivamente. Como conclusión, destacamos la necesidad de comprender la importancia de una correcta preparación prequirúrgica de los pacientes que se van a someter a una dermolipectomía abdominal, para evitar complicaciones en el postoperatorio inmediato y tardío, mejorando así su selección para disminuir la morbilidad de esta intervención quirúrgica.The deforming tetrad of the abdominal wall is formed by obesity, abdominal distension, gravidity and muscle diastases. Our objective is to show the variation of the hematocrit and hemoglobin in relation to the percentage of the total body mass that represents the fatty skin folds extirpated in a dermolipectomy, having as parameter the one obtained 24 hours after surgery and at 7 postoperative day. We design an observational prospective study on 93 patients who underwent an abdominal dermolipectomy between august 1st

  18. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed......: 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...

  19. The effects of maternal labour analgesia on the fetus.

    Science.gov (United States)

    Reynolds, Felicity

    2010-06-01

    Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. Inhalational analgesia using Entonox is more effective and, being rapidly exhaled by the newborn, is less likely to produce lasting depression. Neuraxial analgesia has maternal physiological and biochemical effects, some of which are potentially detrimental and some favourable to the fetus. Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.

  20. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  1. Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2004-06-01

    . Todavia, não se pode dispensar rigorosa vigilância a fim de se obter analgesia satisfatória e diminuir as complicações.JUSTIFICATIVA Y OBJETIVOS: La analgesia promovida por la infusión peridural de anestésico local con analgésicos opioides es reconocidamente de buena calidad y con pocos efectos adversos. El objetivo de este estudio fue determinar el número, formas y gravedad de las complicaciones pós-operatorias relacionadas a la analgesia peridural y a la inserción del catéter peridural. MÉTODO: Fueron evaluados, retrospectivamente, 469 pacientes sometidos a la analgesia peridural pós-operatoria entre 18/10/1999 y 18/10/2001. La analgesia peridural fue conducida usándose solución de bupivacaína 0,1% con fentanil (1 a 5 µg.ml-1, iniciándose la infusión a 3 ml.h-1. La velocidad de infusión era ajustada de acuerdo con la queja álgica del paciente. Fueron analizadas las siguientes variables: la duración de la infusión peridural; la ocurrencia de efectos adversos y complicaciones, relacionándolos a los datos demográficos, tipo de cirugía y posición del catéter peridural; y la calidad de la analgesia obtenida con la técnica (escala analógico-visual de dolor e índice de satisfacción del paciente. RESULTADOS: Los catéteres peridurales permanecieron implantados por una media de 2,2 días, variando de 6 horas a 10 días, y el índice global de complicaciones relacionadas a la técnica fue de 46,3%, siendo que la mayoría fue de pequeña magnitud, sin repercusión clínica. De estas, 13,9% estaban relacionadas directamente al catéter peridural (desconección, exteriorización, dolor lumbar, inflamación e infección local. Otras complicaciones más comunes fueron encontradas: vómitos y retención urinaria. La analgesia pós-operatoria fue efectiva con 97,2% de los pacientes refiriendo satisfacción con la técnica. Pacientes sin dolor o con dolor leve, en el primero, segundo y tercero días de pós-operatorio, constituyeron, respectivamente, 80

  2. Efecto de la hidratación endovenosa con hidroxietil almidón 6% 130/0.4 (voluven®) versus ringer lactato previa a la analgesia epidural en la incidencia de hipotensión durante el trabajo de parto

    OpenAIRE

    Francés González, Sonia

    2015-01-01

    La fluidoterapia endovenosa en las gestantes durante trabajo de parto es fundamental para la prevención de la hipotensión materna tras la analgesia epidural y así mantener el bienestar materno-fetal. El tipo de fluidoterapia administrada, coloides o cristaloides, puede influir en la incidencia de dicha hipotensión. Presentamos los resultados de un estudio prospectivo observacional de 188 gestantes en trabajo de parto. El objetivo principal del estudio fue comparar la incidencia de hipotensión...

  3. Nuestra Experiencia con la técnica de Barcat y Godart en el Torticolis Muscular Congénito

    OpenAIRE

    1990-01-01

    Los autores exponen los resultados obtenidos en diez casos de T.M.C. tratados quirúrgicamente con la técnica de Barcat y Godard, tanto estéticos como funcionales. Se analizan los parámetros de sexo, edad de intervención, lado afectado, tipo de parto, anomalías asociadas, y presencia de asimetría facial, movilidad craneal, pérdida de relieve muscular y aparición de bandas laterales postoperatorias. Estos resultados son comparados con los otros autores, mostrándose superiores....

  4. 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

    Directory of Open Access Journals (Sweden)

    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

  5. Fiebre postoperatoria en cirugía ortopédica y urológica Postoperative fever in orthopedic and urologic surgery

    Directory of Open Access Journals (Sweden)

    Federico Saavedra

    2008-02-01

    Full Text Available La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303 de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42 su etiología fue no infecciosa y en el 19% (8/42 infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (pPost-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303 of which 81% (34/42 was noninfectious and 19% (8/42 was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001. An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19 consisting of chest x-ray, blood (2 and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45 and the blood cultures in only one case (5%, IC 95%: 0.1-26. Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post

  6. Osteomía proximal de la tibia: fijación con tutor tubular AO

    OpenAIRE

    Distéfano, C.A.; Piqué Covone, F.B.

    1997-01-01

    Entre enero de 1988 y diciembre de 1993 se realizaron 64 osteotomías valguizantes infratuberositarias fijadas con tutor tubular AO en 61 pacientes portadores de genu varo artrósico. La edad promedio fue de 48 años. La corrección obtenida se mantuvo hasta la consolidación que se verificó en promedio a las 7 semanas. Se discute la selección de pacientes, los detalles de planificación preoperatoria y de técnica quirúrgica, analizándose rehabilitación postoperatoria, resultados y c...

  7. [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.

  8. Remifentanil for labor analgesia: an evidence-based narrative review.

    Science.gov (United States)

    Van de Velde, M; Carvalho, B

    2016-02-01

    This manuscript reviews the available literature on remifentanil patient-controlled intravenous analgesia in labor focusing on efficacy and safety. Remifentanil compares favorably to other potent systemic opioids but with fewer opioid-related neonatal effects. However, remifentanil provides modest and short-lasting labor analgesia that is consistently inferior when compared to neuraxial analgesia. The initial analgesic effect provided with remifentanil also diminishes as labor progresses. In several studies, remifentanil induced significant respiratory depressant effects in laboring women with episodes of desaturation, hypoventilation and even apnea. Given the safety concerns, we recommend that remifentanil patient-controlled intravenous analgesia should not be a routine analgesia technique during labor. In cases where neuraxial analgesia is refused or contraindicated and the use of remifentanil justified, continuous and careful monitoring is required to detect respiratory depression to provide safe care of both the pregnant woman and unborn child.

  9. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  10. 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...

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

    OpenAIRE

    Fanti, Lorella; Testoni, Pier Alberto

    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 sedat...

  12. Hands-and-knees positioning during labor with epidural analgesia.

    Science.gov (United States)

    Stremler, Robyn; Halpern, Stephen; Weston, Julie; Yee, Jennifer; Hodnett, Ellen

    2009-01-01

    Hands-and-knees position has shown promise as an intervention to improve labor and birth outcomes, but no reports exist that examine its use with women laboring with epidural analgesia. Concerns of safety, effects on analgesia, and acceptability of use may limit use of active positioning during labor with regional analgesia. This article presents a case study series of 13 women who used hands-and-knees position in the first stage of labor.

  13. 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.

  14. Offset analgesia is reduced in older adults.

    Science.gov (United States)

    Naugle, Kelly M; Cruz-Almeida, Yenisel; Fillingim, Roger B; Riley, Joseph L

    2013-11-01

    Recent studies indicate that aging is associated with dysfunctional changes in pain modulatory capacity, potentially contributing to increased incidence of pain in older adults. However, age-related changes in offset analgesia (offset), a form of temporal pain inhibition, remain poorly characterized. The purpose of this study was to investigate age differences in offset analgesia of heat pain in healthy younger and older adults. To explore the peripheral mechanisms underlying offset, an additional aim of the study was to test offset at 2 anatomical sites with known differences in nociceptor innervation. A total of 25 younger adults and 20 older adults completed 6 offset trials in which the experimental heat stimulus was presented to the volar forearm and glabrous skin of the palm. Each trial consisted of 3 continuous phases: an initial 15-second painful stimulus (T1), a slight increase in temperature from T1 for 5 seconds (T2), and a slight decrease back to the initial testing temperature for 10 seconds (T3). During each trial, subjects rated pain intensity continuously using an electronic visual analogue scale (0-100). Older adults demonstrated reduced offset compared to younger adults when tested on the volar forearm. Interestingly, offset analgesia was nonexistent on the palm for all subjects. The reduced offset found in older adults may reflect an age-related decline in endogenous inhibitory systems. However, although the exact mechanisms underlying offset remain unknown, the absence of offset at the palm suggests that peripheral mechanisms may be involved in initiating this phenomenon.

  15. 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 .

  16. 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.

  17. 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.

  18. 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

    Directory of Open Access Journals (Sweden)

    Guilherme Antônio Moreira de Barros

    2003-02-01

    qualidade da analgesia, embora com ocorrência de efeitos colaterais indesejáveis, tendo havido boa aceitação da técnica de analgesia pelas clínicas atendidas.RESUMEN JUSTIFICATIVA Y OBJETIVOS: El rápido progreso obtenido en las técnicas quirúrgicas y anestésicas en los últimos años proporcionó extraordinario aumento de las indicaciones de procedimientos invasivos. Por otro lado, con el envejecimiento de la población, el período de recuperación pós-operatoria pasó a ser motivo de mayor preocupación y consecuente preocupación del equipo de salud. Para tanto, nuevas técnicas de analgesia fueron creadas y desarrolladas y, entre ellas, se destaca la Analgesia Controlada por el Paciente (ACP. En nuestro país, el Servicio de Dolor Agudo (SEDA de la Disciplina de Terapia Antálgica y Cuidados Paliativos, del Departamento de Anestesiología de la Facultad de Medicina de Botucatu - UNESP, utiliza hace muchos años esta técnica de analgesia. Con la finalidad de atestar la calidad del servicio prestado, la pesquisa objetiva verificar la eficacia y seguridad del método, así como identificar y caracterizar la población atendida. MÉTODO: De modo retrospectivo, fueron evaluados 679 pacientes tratados por el SEDA, exclusivamente con el método de ACP, durante tres años. Los pacientes fueron incluidos en el análisis aleatoriamente, sin restricciones cuanto a la edad, al sexo, al tipo de cirugía y considerando únicamente la posibilidad de indicación de la ACP. Fueron estudiados los siguientes atributos: sexo, edad, tipo de cirugía, intensidad del dolor, días de acompañamiento, analgésicos utilizados, vías de administración, ocurrencia de efectos colaterales y complicaciones de la técnica. RESULTADOS 3,96% de los pacientes sometidos a cirugías, y 1,64% de los internados en el período observado, fueron acompañados con técnica ACP. La cirugía torácica fue la más frecuentemente atendida, con 25% de los pacientes. La morfina fue el medicamento m

  19. Evaluación de protocolos de sedación y analgesia con xilazina y dos tasas de infusión continua de morfina en caballos en estación sometidos a castración vía laparascópica

    OpenAIRE

    JD Ruiz; DA Zuluaga; IC Ruiz; Duque, D; MC Ochoa; Escobar, T.

    2015-01-01

    El objetivo de este estudio fue evaluar la utilización de infusión continua de morfina a dos dosis distintas en cuanto a los niveles de sedación y analgesia en castración laparoscópica en caballos. Se utilizaron 14 caballos criollos colombianos, entre tres y seis años, y peso de 239 a 369 kg clínicamente sanos. A los animales se les administró xilazina (0,6 mg/kg IV), morfina (0,05 mg/kg IV) y se asignaron al azar a una infusión continua de morfina (20 o 30 mcg/kg/hora I.V) para posteriorment...

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

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2012-01-01

    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 res

  1. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

    Directory of Open Access Journals (Sweden)

    Samina Ismail

    2013-01-01

    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  2. Influence of adrenergic and cholinergic mechanisms in baclofen induced analgesia.

    Science.gov (United States)

    Tamayo, L; Rifo, J; Contreras, E

    1988-01-01

    1. Baclofen induced analgesia was confirmed by means of the mouse hot plate test. 2. Physostigmine significantly increased the response to baclofen whilst neostigmine was ineffective. Baclofen analgesia was reduced by atropine. 3. The response to baclofen was increased by the administration of tolazoline, propranolol and nadolol. In contrast, the analgesic response to morphine was attenuated by the antiadrenergic drugs phenoxybenzamine, tolazoline and nadolol.

  3. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  4. Complicaciones e impacto de la cirugía de catarata con lente intraocular en la provincia de Sancti Spíritus.

    OpenAIRE

    Elsa E. Cabeza Martínez; Carmen Cardoso Hernández; Melva Ruiz Pérez; Isabel Peral Martínez; Esther Díaz Guzmán

    2006-01-01

    Se realizó un estudio prospectivo longitudinal en el Hospital Universitario “Camilo Cienfuegos “ de Sancti Spíritus en el periodo comprendido del 1ro de septiembre del 2003 al 31 de agosto del 2004 con el objetivo de conocer las complicaciones trans-operatorias y post-operatorias de la cirugía de catarata así como el impacto de esta nueva técnica a través del grado de satisfacción de la población con los servicios quirúrgicos recibidos. El universo de la investigación estuvo integrado po...

  5. Utilidad del citrato fentanilo oral transmucosa (CFOT) para procurar ansiolisis preoperatoria y analgesia postoperatoria en cirugía pediátrica Premedication with oral fentanil (CFOT) in paedriatic surgery

    OpenAIRE

    F. J. Pérez-Bustamante; A. C. Pérez-Guerrero; M. A. Moguel; F. Collado; L. M. Torres

    2008-01-01

    La cirugía en la población infantil representa una fuente de disconfort para el paciente y su entorno familiar que a menudo es infravalorado tanto por éstos como por los profesionales. Aún hay mucho por hacer para disminuir este impacto y proporcionar a los niños unas condiciones emocionales adecuadas para enfrentarse a la cirugía y al postoperatorio. El objetivo de este trabajo era demostrar la utilidad del citrato de fentanilo oral transmucosa (CFOT) como medio de ansiolisis preoperatorio y...

  6. Control radiografico postoperatorio de la instrumentacion con tornillos pediculares toracicos en la escoliosis idiopática del adolescente

    Directory of Open Access Journals (Sweden)

    Pablo Fiorillo

    2013-12-01

    Full Text Available OBJETIVO: Evaluar la eficacia intraoperatoria y postoperatoria de la radiografía en la colocación del tornillo pedícular dorsal y su relación con la tomografía computada (CT. MÉTODOS: Se evaluaron 36 pacientes con escoliosis idiopática del adolescente (EIA. Tres observadores clasifican colocación de los tornillos con radiografia . Estas respuestas se compararon con la tomografía computada. RESULTADOS: Se evaluaron un total de 280 tornillos pediculares. La evaluación interobservador fue de 0,56 (concordancia moderada. La evaluación intraobservador fue 0,79 (concordancia. No se presentaron lesiones vasculares o neurológicas. CONCLUSIONES: Según los resultados intra e interobservador, la reproductibilidad de la radiografía postoperatoria no es muy eficaz para el diagnósticar la mala posición de los tornillos de pedículo dorsales. La tomografía computada fue muy útil para determinar la posición de los tornillos pediculares dorsales.

  7. Relationship between analgesia and turnover of brain biogenic amines.

    Science.gov (United States)

    Bensemana, D; Gascon, A L

    1978-10-01

    The analgesic activity of morphine, delta9THC, and sodium salicylate was studied concomitantly with changes in brainstem and cortex turnover of dopamine (DA), noradrenaline (NA), and serotonin (5HT). The results show that a correlation exists between the presence of analgesia and the increased turnover rates of the three biogenic amines. Morphine and sodium salicylate induced analgesia is accompanied by an increased turnover rate of all three biogenic amines; delta9THC-induced analgesia is accompanied by an increased turnover rate of DA and 5HT only. There is, however, no consistent relationship between the degree of analgesia and the degree of change in the turnover rates. The existence of the endogenous morphine-like substances, endorphines, may explain why morphine analgesia is distinct from that of delta9THC and sodium salicylate. The possible relationship between this morphine-like substance and biogenic amines is discussed.

  8. 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.

  9. A COMPARISON OF ANALGESIA AND FOETAL OUTCOME IN TERM PARTURIENTS WITH AND WITHOUT LOW DOSE COMBINED SPINAL EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Manjunath

    2015-11-01

    Full Text Available : STUDY OBJECTIVE: We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined ‘low dose’ spinal and epidural (CSE. DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia - ‘GROUP T’ and 60 of who underwent a delivery without labour analgesia -‘GROUP C’. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.

  10. Prevalência de paralisia diafragmática após bloqueio de plexo braquial pela via posterior com ropivacaína a 0,2% Prevalencia de parálisis diafragmática después del bloqueo del plexo braquial por la vía posterior con ropivacaína a 0,2% Prevalence of diaphragmatic paralysis after brachial plexus blockade by the posterior approach with 0.2% ropivacaine

    Directory of Open Access Journals (Sweden)

    Marcos Guilherme Cunha Cruvinel

    2006-10-01

    consecuencias es la parálisis diafragmática. En pacientes con algún grado de disfunción pulmonar previa, esa parálisis puede conllevar a la insuficiencia respiratoria. El abordaje del plexo braquial por vía posterior ha conquistado espacio. El objetivo de este estudio fue el de determinar la prevalencia de parálisis diafragmática, después del bloqueo de plexo braquial interescalénico por vía posterior con el uso de ropivacaína a 0,2%. MÉTODO: Veinte y dos pacientes sometidos al bloqueo del plexo braquial interescalénico por vía posterior con ropivacaína a 0,2% fueron evaluados en el postoperatorio con el objetivo de identificar señales radiológicas de elevación de la cúpula diafragmática sugestivas de parálisis hemidiafragmática. En 20 pacientes se utilizó 40 mL de ropivacaína a 0,2%, en ellos fue realizada la radiografía de tórax en inspiración. En dos fueron utilizados 20 mL de ropivacaína a 0,2%, con la siguiente evaluación fluoroscópica. RESULTADOS: No hubo complicaciones relacionadas con la realización del bloqueo. En todos los pacientes, el bloqueo fue efectivo y proporcionó una buena analgesia postoperatoria. Se observó una elevación de la cúpula diafragmática compatible con la parálisis hemidiafragmática en todos los casos estudiados. CONCLUSIONES: En las condiciones de este estudio se pudo observar que el bloqueo del plexo braquial por vía posterior es una técnica que está asociada a la alta prevalencia de parálisis diafragmática, incluso cuando se utilizan bajas concentraciones de anestésico local.BACKGROUND AND OBJECTIVES: Brachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become

  11. Efecto de la analgesia posoperatoria de la morfina endovenosa versus el ketorolaco en citocinas proinflamatorias en colecistectomía laparoscópica

    OpenAIRE

    2012-01-01

    Introducción: el dolor es el principal síntoma posterior al evento quirúrgico y se relaciona con procesos inflamatorios en los que participan citocinas. El dolor posquirúrgico es manejado con analgésicos de tipo opioide de conocida eficacia analgésica como la morfina; se desconoce, sin embargo, su efecto en las concentraciones séricas de las citocinas proinflamatorias al compararse con el ketorolaco. objetivo: determinar el efecto de la analgesia posoperatoria con morfina endovenosa en la act...

  12. [Locally administered ropivacaine vs. standard analgesia for laparoscopic cholecystectomy].

    Science.gov (United States)

    Chavarría-Pérez, Teresa; Cabrera-Leal, Carlos Fernando; Ramírez-Vargas, Susana; Reynada, José Luis; Arce-Salinas, César Alejandro

    2015-01-01

    Introducción: se desconoce qué modalidad analgésica brinda mejores resultados después de una colecistectomía laparoscópica. El objetivo de este estudio consistió en valuar la eficacia analgésica de la ropivacaína usada localmente contra la dipirona por vía intravenosa en colecistectomía laparoscópica. Métodos: ensayo clínico al azar, de no inferioridad, en 50 pacientes con colecistectomía laparoscópica para comparar el uso de ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y en la fosa vesicular frente a dipirona por vía intravenosa. El desenlace primario fue dolor evaluado mediante escala visual análoga (EVA) en las primeras 24 horas. Resultados: el promedio de las EVA de dolor al término de la cirugía fue de 3.8 frente a 3.56 en el grupo de ropivacaína o de dipirona, mientras que a las 6, 12 y 24 horas fueron 2.64 frente a 2.6, 1.92 frente a 1.88 y 1.28 frente a 1.2, respectivamente. No hubo efectos adversos en ningún grupo y la necesidad de rescates analgésicos con tramadol fue similar entre ambos grupos. Conclusiones: la ropivacaína al 0.75 % infiltrada en el lugar de inserción de los trócares y la fosa vesicular muestra una analgesia similar a la dipirona por vía intravenosa en las primeras 24 horas después de una colecistectomía laparoscópica, sin efectos adversos.

  13. 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.

  14. Intracortical modulation, and not spinal inhibition, mediates placebo analgesia.

    Science.gov (United States)

    Martini, M; Lee, M C H; Valentini, E; Iannetti, G D

    2015-02-01

    Suppression of spinal responses to noxious stimulation has been detected using spinal fMRI during placebo analgesia, which is therefore increasingly considered a phenomenon caused by descending inhibition of spinal activity. However, spinal fMRI is technically challenging and prone to false-positive results. Here we recorded laser-evoked potentials (LEPs) during placebo analgesia in humans. LEPs allow neural activity to be measured directly and with high enough temporal resolution to capture the sequence of cortical areas activated by nociceptive stimuli. If placebo analgesia is mediated by inhibition at spinal level, this would result in a general suppression of LEPs rather than in a selective reduction of their late components. LEPs and subjective pain ratings were obtained in two groups of healthy volunteers - one was conditioned for placebo analgesia while the other served as unconditioned control. Laser stimuli at three suprathreshold energies were delivered to the right hand dorsum. Placebo analgesia was associated with a significant reduction of the amplitude of the late P2 component. In contrast, the early N1 component, reflecting the arrival of the nociceptive input to the primary somatosensory cortex (SI), was only affected by stimulus energy. This selective suppression of late LEPs indicates that placebo analgesia is mediated by direct intracortical modulation rather than inhibition of the nociceptive input at spinal level. The observed cortical modulation occurs after the responses elicited by the nociceptive stimulus in the SI, suggesting that higher order sensory processes are modulated during placebo analgesia.

  15. 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.

  16. Concordancia entre histología pre, intra y postoperatoria en cáncer de endometrio

    OpenAIRE

    Serman V.,Felipe; Sánchez A,María Elena; Barrientos F,Bárbara; Saldaña G,Bárbara; Trullen S,Javier; Burky A,Daniela; Calvo S,Paula; Matus I,Maritza; Walton L,Roderick

    2012-01-01

    Antecedentes: En pacientes con cáncer de endometrio se discute la concordancia entre biopsia pre e intraoperatoria versus la definitiva, en grado de diferenciación, tipo histológico y profundidad de mioinvasión. Método: Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de: grado de diferenciación bien diferenciado y tipo histológico sólo endometrioide en biopsia preoperatoria; y grado de diferenciación bien diferenciado, tipo h...

  17. Prevención de adherencias peritoneales postoperatorias mediante uso de antagonista de receptores de neurokinina tipo 1

    OpenAIRE

    GONZÁLEZ-TORRES,CARLOS; UZCÁTEGUI P,ESTRELLA; MILANO M,MELISSE; PLATA-PATIÑO,JOSÉ; NOBOA B,FABIANNE; SHIOZAWA C,NAOAKI

    2010-01-01

    Introducción: La actividad fibrinolítica juega un papel fundamental en el desarrollo de las adherencias peritoneales (AP), y se conoce que la Sustancia P al actuar sobre receptores de neurokinina tipo 1 a nivel peritoneal, disminuye la fibrinólisis, favoreciendo la formación de las mismas. Objetivos: Evaluar la efectividad del tratamiento intraperitoneal con antagonista de receptores 1 de neurokinina (NK-R1A) en la prevención de AP en modelo animal. Materiales y Métodos: A 40 ratas wistar se ...

  18. 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

  19. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

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    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. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    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. PMID:24249984

  1. Post operatory analgesia in caesarean surgery.

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    Bárbara Lucía Cabezas Poblet

    2003-12-01

    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.

  2. Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso Abordaje anestésico de embarazada con malformación arteriovenosa cerebral y hemorragia subaracnoidea durante el embarazo: relato de caso Anesthetic approach of pregnant woman with cerebral arteriovenous malformation and subarachnoid hemorrhage during pregnancy: case report

    Directory of Open Access Journals (Sweden)

    Catarina Santos Carvalho

    2013-04-01

    de 39 semanas, sana antes del embarazo, con antecedentes de HSA a las 22 semanas de gestación que se manifestó por medio de cefaleas, vómitos y mareos, sin la pérdida de la consciencia u otros déficits a la hora de su entrada en el servicio de urgencia. La resonancia magnética (RM arrojó MAV frontal izquierda. Después de un breve período de ingreso para la estabilización y el diagnóstico, se decidió mantener el embarazo y el acompañamiento ambulatorio multidisciplinario por neurocirugía y obstetricia en consulta de alto riesgo. Se optó por realizar la cesárea electiva a las 39 semanas bajo anestesia epidural lumbar. En el intraoperatorio ocurrió un episodio de hipotensión que fue rápidamente revertido con fenilefrina. El Índice de Apgar del recién nacido fue de 10/10. El catéter epidural fue usado para la analgesia postoperatoria, que también cursó sin intercurrencias. CONCLUSIONES: Son muy raros los casos publicados de abordaje anestésico de embarazadas con MAV sintomáticas. Todas las decisiones tomadas por el equipo multidisciplinario, desde optar por continuar con el embarazo, hasta el momento ideal para intervenir la MAV, pasando por el tipo de anestesia y analgesia, fueron sopesadas en función del riesgo de daño cerebral. Desde el punto de vista anestésico, los autores enfatizan la necesidad de estabilidad hemodinámica.BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM. The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. CASE REPORT: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other deficits on admission to the emergency room. Magnetic resonance imaging (MRI revealed a left frontal AVM

  3. Fiebre postoperatoria en pacientes del Cardiocentro Ernesto Che Guevara / Postoperative fever in patients of the Cardiocentro Ernesto Che Guevara

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    Alina Ceballos Álvarez

    2015-08-01

    Full Text Available Introducción: La fiebre es una de las dificultades que se presentan en el período pos-quirúrgico. Objetivo: Caracterizar la incidencia de fiebre en el postoperatorio de cirugía cardio-vascular. Método: Estudio observacional descriptivo, longitudinal, prospectivo, en 31 pacientes con fiebre en el postoperatorio. Resultados: Un 15,6 % del total de pacientes operados de cirugía cardiovascular (31 casos presentó fiebre en el postoperatorio y en 20 de ellos la causa fue séptica. Apareció más frecuentemente en el sexo masculino (74,2 %, tras cirugía de dos vál-vulas o de revascularización miocárdica (67,7 %, y en el grupo etario de 30-49 años (48,9 %. Fueron más encontrados los derrames pleurales (29,0 % y pericárdicos (19,4 %, y las lesiones inflamatorias pulmonares (25,8 %; la mayoría de los enfermos tenían colocados 2 catéteres venosos centrales (77,4 % y llevaban más de tres días con sonda vesical (51,6 % o línea arterial (48,4 %; al 87,1 % de los pacientes se le administró metamizol, al 58,1 % antimicrobianos y al 25,8 % se le tomó muestra para hemocultivo. Los gérmenes más encontrados fueron la pseudomona y el acinetobác-ter y predominó la evolución satisfactoria (solo 1 paciente fallecido. Conclusiones: La frecuencia de aparición de la fiebre en el postoperatorio de cirugía cardiovascular no fue elevada y predominó en hombres, entre 30 y 49 años de edad, con cirugía compleja. Fueron más encontrados los derrames pericárdico y pleural, así como la utilización de varios procedimientos invasivos. El hemocultivo fue útil para determinar la causa de la fiebre y el germen. La mayoría de los pacientes evolucionó satisfactoriamente.

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

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    Rolando T. Espín González

    >Fundamento: El dolor posoperatorio constituye un problema muy difundido y constante en los cuidados del paciente quirúrgico. La lucha por encontrar nuevas terapéuticas para aliviar el dolor ha llevado a la fabricación y uso de gran variedad de analgésicos que son administrados por diferentes vías. Se conocen bien los efectos de los narcóticos en el recién nacido y fue la preocupación al respecto lo que motivó el interés por el uso de esos fármacos por vía epidural e intratecal en la paciente obstétrica. Objetivo: Evaluar la factibilidad del uso de morfina liofilizada por vía peridural en la operación cesárea. Métodos : Estudio de serie de casos desarrollado durante el periodo comprendido entre febrero del 2001 a agosto del 2002 en la unidad quirúrgica del Servicio de Ginecoobstetricia del Hospital Universitario ¨Dr.Gustavo Aldereguía Lima¨ de Cienfuegos, que incluyó 120 pacientes sometidas a cesárea iterativa electiva. Se analizaron variables correspondientes a tensión arterial, frecuencia cardiaca, frecuencia respiratoria durante el preoperatorio, transoperatorio y posoperatorio, comienzo del efecto anestésico y duración de este, además se analizaron las complicaciones perioperatorias, la calidad de la analgesia posoperatoria y su repercusión en el recién nacido, medida mediante el puntaje de Apgar. El procesamiento estadístico se realizó utilizando el paquete estadístico Epi Info 6. Resultados : El comienzo del efecto anestésico y el tiempo de duración de la anestesia no se modificaron con el uso de la morfina liofilizada. Los parámetros vitales se mantuvieron con valores normales en la mayoría de las pacientes durante el preoperatorio, transoperatorio y posoperatorio. Las complicaciones que se presentaron fueron: prurito, retención urinaria, náuseas y vómitos. La calidad de la analgesia resultó satisfactoria en la mayoría de las paciente

  5. Proinflammatory cytokines oppose opioid induced acute and chronic analgesia

    OpenAIRE

    Hutchinson, Mark R.; Coats, Benjamen D; Lewis, Susannah S.; Zhang, Yingning; Sprunger, David B.; Rezvani, Niloofar; Baker, Eric M.; Jekich, Brian M.; Wieseler, Julie L.; Somogyi, Andrew A; Martin, David; Poole, Stephen; Judd, Charles M.; Steven F. Maier; Watkins, Linda R.

    2008-01-01

    Spinal proinflammatory cytokines are powerful pain-enhancing signals that contribute to pain following peripheral nerve injury (neuropathic pain). Recently, one proinflammatory cytokine, interleukin-1, was also implicated in the loss of analgesia upon repeated morphine exposure (tolerance). In contrast to prior literature, we demonstrate that the action of several spinal proinflammatory cytokines oppose systemic and intrathecal opioid analgesia, causing reduced pain suppression. In vitro morp...

  6. Stability of piritramide in patient-controlled analgesia (PCA) solutions.

    Science.gov (United States)

    Remane, D; Scriba, G; Meissner, W; Hartmann, M

    2009-06-01

    For patient controlled analgesia, syringes with solutions of 1.5 mg/ml piritramide in 0.9% aqueous sodium chloride are used. The physical and chemical stability for dilutions of the commercially available preparation of piritramide is limited up to 72 hours by the manufacturer. Since application duration for patient-controlled analgesia can exceed that limited time, stability was investigated by HPLC. Our results show that these solutions are chemically stable over a time period of 60 days.

  7. 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

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    ão necessários para avaliar diferença na incidência de cesarianas.JUSTIFICATIVA Y OBJETIVOS: El alivio del dolor en el trabajo de parto ha recibido una atención constante objetivando el bienestar materno, disminuyendo el estrés causado por el dolor y reduciendo las consecuencias de éste sobre el concepto. Innumerables técnicas pueden ser utilizadas para la analgesia de parto. Este trabajo tuvo como objetivo comparar la técnica peridural continua con la combinada, ambas con el uso de bupivacaína a 0,25% en exceso enantiomérico 50% y fentanil como agentes. MÉTODO: Participaron del estudio 40 parturientes en trabajo de parto con dilatación cervical entre 4 y 5 cm que se repartieron en de los grupos iguales de forma aleatoria. El Grupo I recibió anestesia peridural continua. El Grupo II recibió anestesia combinada. Se evaluaron: medidas antropométricas, edad de embarazo, dilatación cervical, tiempo entre el bloqueo y la ausencia de dolor a través de la escala analógica visual, posibilidad de deambulación, tiempo entre el inicio de la analgesia y la dilatación cervical completa, duración del período expulsivo, parámetros hemodinámicos maternos y vital edad del recién nacido. Posibles complicaciones como depresión respiratoria, hipotensión arterial materna, prurito, náuseas y vómitos también fueron observados. Para la comparación de los promedios se utilizó el teste t de Student y para la paridad y tipo de parto se utilizó el teste del Qui-cuadrado. RESULTADOS: No hubo diferencia estadística significativa entre los de los grupos con relación al tiempo entre el inicio de la analgesia y la dilatación cervical completa, como también con relación al tiempo de la duración del período expulsivo, incidencia de cesárea relacionada con la analgesia, parámetros hemodinámicos maternos y vital edad del recién nacido. CONCLUSIONES: Las dos técnicas fueron eficaces y seguras para la analgesia del trabajo de parto, aunque la técnica combinada haya

  8. 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

  9. Peripheral morphine analgesia in dental surgery.

    Science.gov (United States)

    Likar, R; Sittl, R; Gragger, K; Pipam, W; Blatnig, H; Breschan, C; Schalk, H V; Stein, C; Schäfer, M

    1998-05-01

    The recent identification of opioid receptors on peripheral nerve endings of primary afferent neurons and the expression of their mRNA in dorsal root ganglia support earlier experimental data about peripheral analgesic effects of locally applied opioids. These effects are most prominent under localized inflammatory conditions. The clinical use of such peripheral analgesic effects of opioids was soon investigated in numerous controlled clinical trials. The majority of these have tested the local, intraarticular administration of morphine in knee surgery and have demonstrated potent and long-lasting postoperative analgesia. As the direct application of morphine into the pain-generating site of injury and inflammation appears most promising, we examined direct morphine infiltration of the surgical site in a unique clinical model of inflammatory tooth pain. Forty-four patients undergoing dental surgery entered into this prospective, randomized, double-blind study. Before surgery they received, together with a standard local anesthetic solution (articaine plus epinephrine) a submucous injection of either 1 mg of morphine (group A) or saline (group B). Postoperative pain intensity was assessed using the visual analog scale (VAS) and numeric rating scale (NRS) at 2, 4, 6, 8, 10, 12, 16, 20 and 24 h after surgery. In addition, patients recorded the occurrence of side effects and the supplemental consumption of diclofenac tablets. Results of 27 patients were analyzed (group A: n=14, group B: n=13). Pain scores which were moderate to severe preoperatively were reduced to a similar extent in both groups up to 8 h postoperatively. Thereafter, pain scores in group A were significantly lower than those in group B for up to 24 h, demonstrating the analgesic efficacy of additional morphine. The time to first analgesic intake and the total amount of supplemental diclofenac were less in group A than in group B. No serious side effects were reported. Our results show that 1 mg of

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

    Directory of Open Access Journals (Sweden)

    Carlos M. Hernández

    2005-12-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective....... 1, p = 0.31). 30-day mortality was 1 vs. 2, p = 0.54. CONCLUSIONS: In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed...

  12. Bloqueo de los nervios iliohipogástrico e ilioinguinal para analgesia posquirúrgica en cesárea tipo Pfannenstiel realizada bajo anestesia general: ¿qué concentración del anestésico local usar? Iliohypogastric and ilioinguinal block for postsurgical analgesia after pfannenstiel cesarean section performed under general anaesthesia

    Directory of Open Access Journals (Sweden)

    Héctor Iván García García

    1998-03-01

    Full Text Available El bloqueo bilateral de los nervios Iliohipogástrico e Ilioinguinal con bupivacaína al 0.5% puede proveer analgesia luego de cesárea con incisión de Pfannenstiel aunque la cantidad de droga usada está cerca de la dosis máxima segura. Diseñamos este estudio para comparar el efecto analgésico de la bupivacaína al 0.5% y diluida al 0.25%. Se incluyeron treinta pacientes aleatoriamente asignadas a un grupo de estudio (bupivacaína 0.25%, n= 15 y uno de control (bupivacaína 0.5%, n=15. Se evaluaron las pacientes con una Escala Visual Análoga (EVA a las O, 4, 8, 12 y 24 horas posoperatorias por médicos que no sabían a qué grupo pertenecían y sólo en caso de necesidad se prescribió analgesia IM con Diclofenaco. Los puntajes de analgesia y los requerimientos de anal. gesia complementaria fueron notoriamente simila. res en ambos grupos y no hubo diferencias estadísticamente significativas. Concluimos que el bloqueo de estos nervios es una técnica analgésica efectiva (el dolor siempre estuvo en promedio por debajo de 4 en la EVA, que no es afectada por la dilución del anestésico y que además es segura pues no se presentaron complicaciones. The Iliohypogastric and Ilioinguinal bilate. ral block with 0.5% bupivacaine can provide analgesia after Pfannenstiel cesarean section although the required amount of the drug is near the maximum secure dose. We designed this study in order to compare the analgesic effect of 0.5% bupivacaine and diluted 0.25% bupivacaine. Thirty patients were included in the study and asigned in aleatory form to either a study (0.25% bupivacaine n=15 or a control group (0.5% bupivacaine n=15. They were evaluated with the Visual Analogue Scale (VAS at 0,4,8,12,24 postoperative hours by physicians who did not know the group of the patient and prescribed intramuscular analgesia with Dicofenac only if required. The analgesia scores and the complementery analgesia requirements were similar in both groups and there were

  13. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  14. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  15. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  16. Newborn Analgesia Mediated by Oxytocin during Delivery.

    Science.gov (United States)

    Mazzuca, Michel; Minlebaev, Marat; Shakirzyanova, Anastasia; Tyzio, Roman; Taccola, Giuliano; Janackova, Sona; Gataullina, Svetlana; Ben-Ari, Yehezkel; Giniatullin, Rashid; Khazipov, Rustem

    2011-01-01

    The mechanisms controlling pain in newborns during delivery are poorly understood. We explored the hypothesis that oxytocin, an essential hormone for labor and a powerful neuromodulator, exerts analgesic actions on newborns during delivery. Using a thermal tail-flick assay, we report that pain sensitivity is two-fold lower in rat pups immediately after birth than 2 days later. Oxytocin receptor antagonists strongly enhanced pain sensitivity in newborn, but not in 2-day-old rats, whereas oxytocin reduced pain at both ages suggesting an endogenous analgesia by oxytocin during delivery. Similar analgesic effects of oxytocin, measured as attenuation of pain-vocalization induced by electrical whisker pad stimulation, were also observed in decerebrated newborns. Oxytocin reduced GABA-evoked calcium responses and depolarizing GABA driving force in isolated neonatal trigeminal neurons suggesting that oxytocin effects are mediated by alterations of intracellular chloride. Unlike GABA signaling, oxytocin did not affect responses mediated by P2X3 and TRPV1 receptors. In keeping with a GABAergic mechanism, reduction of intracellular chloride by the diuretic NKCC1 chloride co-transporter antagonist bumetanide mimicked the analgesic actions of oxytocin and its effects on GABA responses in nociceptive neurons. Therefore, endogenous oxytocin exerts an analgesic action in newborn pups that involves a reduction of the depolarizing action of GABA on nociceptive neurons. Therefore, the same hormone that triggers delivery also acts as a natural pain killer revealing a novel facet of the protective actions of oxytocin in the fetus at birth.

  17. 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.

  18. Book review. Anestesia e analgesia locoregionale del cane e del gatto. Francesco Staffieri

    Directory of Open Access Journals (Sweden)

    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.

  19. 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

    estudios en un área con tantas lagunas de conocimiento en nuestro medio.This is a first-time study in Brazil, which identified the relations between the analgesic standard and trauma severity. To do this, an analysis was performed in a population of 200 traffic accident victims admitted for treatment at the emergency unit of a referral hospital for trauma care in the city of São Paulo. Trauma and lesion severity were characterized by anatomic severity indexes. Based on the analysis of the analgesic therapy, analgesia standards were constructed, founded on the World Health Organization analgesic scale. The results permitted to identify the statistic association between trauma severity and distinct analgesia standards. The dissemination of these findings could serve as the basis to design analgesia protocols in trauma and improve care quality, besides encouraging the development of studies in an area with so many knowledge gaps.

  20. 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...

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

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk;

    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...

  2. 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.

  3. 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.

  4. Estudo comparativo entre bupivacaína (S75-R25 e ropivacaína em bloqueio peridural para analgesia de parto Estudio comparativo entre la bupivacaína (S75-R25 y la ropivacaína en bloqueo epidural para analgesia de parto A comparative study between bupivacaine (S75-R25 and ropivacaine in spinal anesthesia for labor analgesia

    Directory of Open Access Journals (Sweden)

    Celso Schmalfuss Nogueira

    2010-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A anestesia peridural é utilizada para alívio da dor no trabalho de parto e está associada a baixos índices de complicações. Estudos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função da menor cardiotoxicidade. Este estudo teve o objetivo de avaliar a latência e a duração da analgesia e as repercussões maternas e fetais com o emprego da bupivacaína (S75-R25 e da ropivacaína quando utilizadas para analgesia de parto por bloqueio peridural. MÉTODOS: Realizou-se um ensaio clínico prospectivo, duplamente encoberto e aleatório, de 49 pacientes gestantes de termo, apresentando baixo risco, com indicação de parto vaginal, idade entre 15 e 35 anos, ASA I ou II distribuídas em dois grupos: GI - bupivacaína (S75-R25 0,25%; GII - ropivacaína a 0,20%. RESULTADOS: Evidenciou-se diferença estatisticamente significante entre os dois grupos 30 minutos após a instalação da peridural, sendo os escores de dor maiores no grupo que utilizou a ropivacaína. Não foram encontradas diferenças estatísticas significativas quanto a latência de analgesia, nível sensorial do bloqueio, volume de anestésico local, dose de resgate, duração do trabalho de parto e da analgesia, frequência de parto instrumental, alterações hemodinâmicas, escores de Apgar ou pH do cordão umbilical e incidência de eventos adversos. CONCLUSÕES: O uso de bupivacaína (S75-R25 e ropivacaína para a analgesia de parto proporcionou boas condições para a realização da anestesia peridural com pequenas ocorrências de eventos adversosJUSTIFICATIVA Y OBJETIVOS: La anestesia epidural se usa para el alivio del dolor en el parto y está asociada a bajos índices de complicaciones. Estudios con enantiómeros levógiros de los anestésicos locales, han demostrado una seguridad más elevada en función de una menor cardiotoxicidad. Este estudio quiso evaluar la latencia y la duración de la analgesia y

  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

    Directory of Open Access Journals (Sweden)

    Esra Mercanoğlu

    2013-04-01

    ón por vía intravenosa o epidural de morfina, bupivacaína o ropivacaína en el tratamiento del dolor pos toracotomía. MÉTODOS: Sesenta pacientes sometidos a procedimientos de toracotomía electiva fueron aleatoriamente ubicados en cuatro grupos con el uso de la técnica de sobres lacrados. Los grupos MIV, ME, MEB y MER recibieron morfina controlada por el paciente por vía intravenosa, epidural, morfina-bupivacaína y morfina-ropivacaína, respectivamente. La frecuencia cardíaca, presión arterial y la saturación de oxígeno perioperatorias y el dolor postoperatorio en reposo y durante la tos, los efectos colaterales y la necesidad de analgésicos de rescate fueron registrados a los 30 y 60 minutos y las 2, 4, 6, 12, 24, 36, 48 y 72 horas. RESULTADOS: La necesidad de sodio diclofenaco durante el estudio fue menor en el grupo ME. El área bajo la curva de tiempo en la VAS fue menor en el grupo ME en comparación con el Grupo MIV, pero similar al Grupo MEB y MER. Las puntuaciones de dolor en reposo fueron mayores en los tiempos 12, 24, 36 y 48 horas en el Grupo MIV en comparación con el grupo ME. Las puntuaciones de dolor en reposo fueron mayores a los 30 y 60 minutos en los Grupos ME y MIV en comparación con el Grupo MEB. Las puntuaciones de dolor durante la tos a los 30 minutos fueron mayores en el grupo ME en comparación con el Grupo MEB. No hubo diferencia entre los Grupos MIV y MER. CONCLUSIONES: La morfina administrada por vía epidural fue más eficaz que por la vía intravenosa. La eficacia fue mayor en el grupo EM en el período postoperatorio tardío y en el Grupo MEB en el período postoperatorio inicial. Concluimos entonces que la morfina administrada por vía epidural fue la más eficaz y nuestra preferida.BACKGROUND AND OBJECTIVEs: The aim of this randomized, double-blinded, prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine, bupivacaine or ropivacaine on post-thoracotomy pain management

  6. Effect of sufentanil combined with different concentrations of ropivacaine for labor analgesia on maternal

    Institute of Scientific and Technical Information of China (English)

    Han-He Wang; Min-Jia Jiang; Wan-Dong Liao

    2016-01-01

    Objective:To study the effect of sufentanil combined with different concentration of ropivacaine for stepped analgesia on stage of labor, stress indexes and blood coagulation function.Methods:A total of 178 cases of full-term singleton primiparas who awaited delivery and received epidural labor analgesia in our hospital from January 2015 to June 2016 were selected and randomly divided into stepped analgesia group and routine analgesia group, and the stage of labor, levels of stress hormones and pain mediators during childbirth and blood coagulation function indexes after childbirth were observed between two groups.Results: The duration of latent phase of labor of stepped analgesia group was shorter than that of routine analgesia group while the duration of active phase of labor, the duration of second stage of labor and the duration of third stage of labor were not significantly different from those of routine analgesia group; serum PRL level of stepped analgesia group was significantly higher than that of routine analgesia group while PA, NE, E, DYN,β-EP, SP, PGE2, 5-HT, TF, TFPI, FPA, AT-III and DD levels were not significantly different from those of routine analgesia group.Conclusions: Sufentanil combined with different concentration of ropivacaine for stepped analgesia is with equivalent effect to routine analgesia, and can shorten the latent phase of labor and reduce the inhibitory effect of pain on prolactin without affecting the degree of stress during childbirth and the blood coagulation function after childbirth.

  7. Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?

    Science.gov (United States)

    Staud, Roland

    2007-12-01

    Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.

  8. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    Intravenous patient-controlled therapy is used routinely in postoperative care in much of the developed world. Intravenous patient-controlled analgesia results in higher patient satisfaction than conventional administration of analgesics, although it appears to have no advantage over conventional...... analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...... consideration. For example, opioid-tolerant patients need higher postoperative opioid doses to achieve satisfactory analgesic effect. In patients with renal or hepatic insufficiency, the elimination of some opioids may be substantially impaired, and the optimal opioid should be selected based on its...

  9. 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.

  10. Regional anesthesia and analgesia for oral and dental procedures.

    Science.gov (United States)

    Rochette, Judy

    2005-07-01

    Regional anesthesia and analgesia benefit the client, the patient, and the practitioner, and their use is becoming the standard for care. Familiarity with the processes involved in the generation of pain aids in understanding the benefits of preemptive and multimodal analgesia. Local anesthetic blocks should be a key component of a treatment plan, along with opioids, nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate receptor antagonists, and other therapies. Nerve blocks commonly used for dentistry and oral surgery include the infraorbital, maxillary, mental,and mandibular blocks.

  11. Effects of hypnotic focused analgesia on dental pain threshold.

    Science.gov (United States)

    Facco, Enrico; Casiglia, Edoardo; Masiero, Serena; Tikhonoff, Valery; Giacomello, Margherita; Zanette, Gastone

    2011-01-01

    The rate, intensity, and selectivity of hypnotic focused analgesia (HFA) were tested with dental pulp stimulation. Thirty-one healthy subjects were hypnotized, and hypnotic suggestions were given for anesthesia of the right mandibular arch. A posthypnotic suggestion of persisting analgesia was also given. The pain threshold of the first premolar was bilaterally measured before, during, and after hypnosis using a pulp tester. During hypnosis, the pain threshold increased significantly (p < .0001) for both sides. The posthypnotic right pain threshold was also significantly (p < .0015) higher than in the basal condition.

  12. 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.

  13. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... the epidural to the birth, and the relationship to the midwife. Place of origin: The labor ward, Aalborg Sygehus Nord, Aalborg. The homes of the women. Method: Field study and interviews. Nine women were observed from the establishment of the epidural until birth. They were interviewed the day after the birth...

  14. 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.

  15. 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

  16. Analgesia pós-operatória para cesariana: a adição de clonidina à morfina subaracnóidea melhora a qualidade da analgesia? Analgesia postoperatória para cesárea: ¿la adición de clonidina a la morfina subaracnoidea mejora la calidad de la analgesia? Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?

    Directory of Open Access Journals (Sweden)

    José Francisco Nunes Pereira das Neves

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O mecanismo de ação analgésica a2-adrenérgico tem sido explorado há mais de 100 anos. A clonidina aumenta de maneira dose-dependente a duração dos bloqueios sensitivo e motor e tem propriedades antinociceptivas. O objetivo desse estudo foi avaliar se a adição de clonidina na dose de 15 e 30 µg à raquianestesia, para cesariana, com bupivacaína hiperbárica a 0,5% (12,5 mg e morfina (100 µg, melhora a qualidade da analgesia pós-operatória. MÉTODO: Foi realizado um estudo prospectivo e aleatório com 60 pacientes divididas em três grupos: BM - bupivacaína hiperbárica a 0,5% (12,5 mg e morfina (100 µg, BM15 - bupivacaína hiperbárica a 0,5% (12,5 mg, morfina (100 µg e clonidina (15 µg e BM30 - bupivacaína hiperbárica a 0,5% (12,5 mg, morfina (100 µg e clonidina (30 µg, administradas separadamente. No peri-operatório, foram anotados o consumo de efedrina e a avaliação do recém-nascido pelo índice de Apgar. No pós-operatório, a dor foi avaliada na 12ª h pela Escala Analógica Visual, o tempo para solicitação de analgésicos e efeitos colaterais pós-operatórios, como prurido, náuseas, vômitos, bradicardia, hipotensão arterial e sedação. Os valores foram considerados significativos quando p JUSTIFICATIVA Y OBJETIVOS: El mecanismo de acción analgésica alfa2-adrenérgico ha venido siendo investigado hace más de cien años. La clonidina aumenta de manera dosis-dependiente la duración de los bloqueos sensitivo y motor y tiene propiedades antinociceptivas. El objetivo de este estudio fue el de evaluar si la adición de clonidina en las dosis de 15 y 30 µg a raquianestesia, para cesárea, con bupivacaína hiperbárica a 0,5% (12,5 mg y morfina (100 µg, mejora la calidad de la analgesia postoperatória. MÉTODO: Se realizó un estudio prospectivo, aleatorio con 60 pacientes y divididos en 3 grupos: BM - bupivacaína hiperbárica a 0,5% (12,5 mg y morfina (100 µg, BM15 - bupivaca

  17. Meningite após técnica combinada para analgesia de parto: relato de caso Meningitis después de técnica combinada para analgesia de parto: relato de caso Meningitis after combined spinal-epidural analgesia for labor: case report

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2002-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Meningite é uma complicação grave em anestesia regional, embora rara de ocorrer. O objetivo deste relato é mostrar um caso de uma paciente que evoluiu com meningite após realização de analgesia de parto pela técnica combinada (raqui-peridural com dupla punção. RELATO DO CASO: Paciente com 25 anos, segunda gestação e cesariana anterior, em trabalho de parto. Foi realizada analgesia de parto pela técnica combinada (raqui-peridural com dupla punção. Após 24 horas apresentou cefaléia em repouso, picos de hipertermia, calafrios discretos, que regrediram com medicação sintomática. No 5º dia a cefaléia piorou. No 10º dia surgiram vômitos e dor na nuca. No 13º dia os sintomas tornaram-se mais intensos. Foi realizada punção lombar. A história clínica e o exame do líquor foram compatíveis com meningite bacteriana. CONCLUSÕES: A técnica combinada (raqui-peridural para analgesia do parto está próxima do ideal. Cuidados com a técnica de anti-sepsia são necessários para realização de bloqueios espinhais. A complicação apresentada ocorreu sem a aparente falha na realização da técnica, sendo uma questão que é inerente ao risco-benefício que a técnica proporciona.JUSTIFICATIVA Y OBJETIVOS: Meningitis es una complicación grave en anestesia regional, no obstante, rara de ocurrir. El objetivo de este relato es mostrar un caso de una paciente que evolucionó con meningitis después de realización de analgesia de parto por la técnica combinada (raqui-peridural con dupla punción. RELATO DEL CASO: Paciente con 25 anos, segunda gestación y cesariana anterior, en trabajo de parto. Fue realizada analgesia de parto por la técnica combinada (raqui-peridural con dupla punción. Después de 24 horas presentó cefalea en reposo, picos de hipertermia, calofríos discretos, que mejoraron con medicación sintomática. En el 5º día la cefalea peoró. En el 10º día surgieron vómitos y dolor en la

  18. Anestesia em paciente com doença de Steinert: relato de caso Anestesia en paciente con enfermedad de Steinert: relato de caso Anesthesia in a patient with Steinert disease: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Souza Araújo

    2006-12-01

    g.mL-1 en bomba de infusión blanco controlada. La analgesia postoperatoria fue realizada con dipirona (1,5 g e infiltración local de ropivacaína a 0,5% (150 mg. El paciente desarrolló, en el intraoperatorio, crisis miotónica (10 minutos después ser colocado en posición de litotomía, que fue controlada con sedación (aumento de la concentración blanco para 1,5 ìg.mL-1 y bolus de 40 mg. Permaneció estable y tuvo alta hospitalaria al día siguiente. CONCLUSIONES: El conocimiento de la enfermedad y la planificación anestésica son de fundamental importancia en el manoseo de pacientes portadores de la enfermedad de Steinert.BACKGROUND AND OBJECTIVES: Steinert disease is the most common muscular dystrophy of the adult. Due to its multisystem characteristic, the perioperative management of these patients is a challenge to the anesthesiologist. The aim of this report was to present a case of hemorrhoidectomy in a patient with muscular dystrophy and to discuss the several anesthetic implications involved. CASE REPORT: A man patient, 58 years old, with Steinert disease, who underwent hemorrhoidectomy. Subaracnoid block with hyperbaric bupivacaine (saddle block with puncture at L3-L4 with 0.5% bupivacaine [5 mg] associated with sedation with propofol (1 µg.mL-1 target using a target-controlled infusion pump. Dypirone (1.5 g and local infiltration with 0.5% ropivacaine (150 mg were used for the postoperative analgesia. Intraoperatively, the patient developed myotonic crisis (10 minutes after being placed on the litothomy position that was controlled by sedation (the target concentration was increased to 1.5 µg.mL-1 and given a bolus of 40 mg. The patient remained stable and was discharged the following day. CONCLUSIONS: The knowledge about the disease and the proper anesthetic planning are extremely important when managing patients with Steinert disease.

  19. Mechanisms of acupuncture analgesia for clinical and experimental pain.

    Science.gov (United States)

    Staud, Roland; Price, Donald D

    2006-05-01

    There is convincing evidence that acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting, as well as postoperative dental pain. Less convincing data support AP's efficacy for chronic pain conditions, including headache, fibromyalgia and low back pain. There is no evidence that AP is effective in treating addiction, insomnia, obesity, asthma or stroke deficits. AP seems to be efficacious for alleviating experimental pain by increasing pain thresholds in human subjects and it appears to activate analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes some time to develop and to resolve. Furthermore, repetitive use of AP analgesia can result in tolerance that demonstrates cross-tolerance with morphine. However, it appears that not all forms of AP are equally effective for providing analgesia. In particular, electro-AP seems to best deliver stimuli that activate powerful opioid and nonopioid analgesic mechanisms. Thus, future carefully controlled clinical trials using adequate electro-AP may be able to provide the necessary evidence for relevant analgesia in chronic pain conditions, such as headache, fibromyalgia, irritable bowel syndrome and low back pain.

  20. 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....

  1. Bayesian prediction of placebo analgesia in an instrumental learning model

    Science.gov (United States)

    Jung, Won-Mo; Lee, Ye-Seul; Wallraven, Christian; Chae, Younbyoung

    2017-01-01

    Placebo analgesia can be primarily explained by the Pavlovian conditioning paradigm in which a passively applied cue becomes associated with less pain. In contrast, instrumental conditioning employs an active paradigm that might be more similar to clinical settings. In the present study, an instrumental conditioning paradigm involving a modified trust game in a simulated clinical situation was used to induce placebo analgesia. Additionally, Bayesian modeling was applied to predict the placebo responses of individuals based on their choices. Twenty-four participants engaged in a medical trust game in which decisions to receive treatment from either a doctor (more effective with high cost) or a pharmacy (less effective with low cost) were made after receiving a reference pain stimulus. In the conditioning session, the participants received lower levels of pain following both choices, while high pain stimuli were administered in the test session even after making the decision. The choice-dependent pain in the conditioning session was modulated in terms of both intensity and uncertainty. Participants reported significantly less pain when they chose the doctor or the pharmacy for treatment compared to the control trials. The predicted pain ratings based on Bayesian modeling showed significant correlations with the actual reports from participants for both of the choice categories. The instrumental conditioning paradigm allowed for the active choice of optional cues and was able to induce the placebo analgesia effect. Additionally, Bayesian modeling successfully predicted pain ratings in a simulated clinical situation that fits well with placebo analgesia induced by instrumental conditioning. PMID:28225816

  2. 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

  3. Analgesia in the horse, assessing and treating pain in equines

    NARCIS (Netherlands)

    Loon, Thijs van

    2012-01-01

    This review focuses on pain and nociception in horses and is based on the PhD thesis “Analgesia in the Horse, various approaches for assessment and treatment of pain and nociception in equines” by J.P.A.M. van Loon. Apart from a scientific review of the related literature, a multi-disciplinary appro

  4. Information Models of Acupuncture Analgesia and Meridian Channels

    Directory of Open Access Journals (Sweden)

    Chang Hua Zou

    2010-12-01

    Full Text Available Acupuncture and meridian channels have been major components of Chinese and Eastern Asian medicine—especially for analgesia—for over 2000 years. In recent decades, electroacupuncture (EA analgesia has been applied clinically and experimentally. However, there were controversial results between different treatment frequencies, or between the active and the placebo treatments; and the mechanisms of the treatments and the related meridian channels are still unknown. In this study, we propose a new term of infophysics therapy and develop information models of acupuncture (or EA analgesia and meridian channels, to understand the mechanisms and to explain the controversial results, based on Western theories of information, trigonometry and Fourier series, and physics, as well as published biomedical data. We are trying to build a bridge between Chinese medicine and Western medicine by investigating the Eastern acupuncture analgesia and meridian channels with Western sciences; we model the meridians as a physiological system that is mostly constructed with interstices in or between other physiological systems; we consider frequencies, amplitudes and wave numbers of electric field intensity (EFI as information data. Our modeling results demonstrate that information regulated with acupuncture (or EA is different from pain information, we provide answers to explain the controversial published results, and suggest that mechanisms of acupuncture (or EA analgesia could be mostly involved in information regulation of frequencies and amplitudes of EFI as well as neuronal transmitters such as endorphins.

  5. Side effects of pain and analgesia in animal experimentation.

    Science.gov (United States)

    Jirkof, Paulin

    2017-03-22

    This review highlights selected effects of untreated pain and of widely used analgesics such as opioids, non-steroid anti-inflammatory drugs and antipyretics, to illustrate the relevance of carefully planned, appropriate and controlled analgesia for greater reproducibility in animal experiments involving laboratory rodents.

  6. Analgesia and anesthesia for neonates : Study design and ethical issues

    NARCIS (Netherlands)

    Anand, KJS; Aranda, JV; Berde, CB; Buckman, S; Capparelli, EV; Carlo, WA; Hummel, P; Lantos, P; Johnston, CC; Lehr, VT; Lynn, AM; Oberlander, TF; Raju, TNK; Soriano, SG; Taddio, A; Walco, GA; Maxwell, L.G.

    2005-01-01

    Objective: The purpose of this article is to summarize the clinical, methodologic, and ethical considerations for researchers interested in designing future trials in neonatal analgesia and anesthesia, hopefully stimulating additional research in this field. Methods: The MEDLINE, PubMed, EMBASE, and

  7. 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.

  8. EFFECT OF INTRATHECAL CLONIDINE ON DURATION OF SPINAL ANALGESIA

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    Sourabh

    2015-06-01

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

  9. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam Analgesia pos-operatoria multimodal en cirugía ginecológica videolaparoscópica ambulatorial: comparación entre parecoxib y tenoxican Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2005-04-01

    tenoxican venoso en un estudio doblemente encubierto. MÉTODO: Fueron estudiadas prospectivamente 60 pacientes divididas de forma aleatoria en 2 grupos. Todas recibieron sedación pre-operatoria con midazolan. Un de los grupos (P recibió antes de iniciar la cirugía 40 mg de parecoxib y en el otro (T 20 mg de tenoxican. En la sala de operación fue hecha raquianestesia con bupivacaína y sufentanil. La analgesia pos-operatoria fue evaluada mediante la intensidad del dolor con escalas verbal y visual, localización del dolor (incisional, visceral, en el hombro y el consumo de analgésicos suplementares. Fueron registrados los efectos colaterales adversos La satisfacción de la paciente con la técnica fue pesquisada. RESULTADOS: La calidad analgésica fue excelente, con 76% de las pacientes del grupo P y 83% de las pacientes del grupo T sin queja de dolor y tampoco el uso de analgésicos en el pos-operatorio. No hubo diferencia entre los grupos en todos los criterios y períodos de evaluación analgésica. La incidencia de efectos adversos fue pequeña, no obstante, prurito de intensidad leve y de corta duración ocurrió frecuentemente. Todas las pacientes quedaron satisfechas o también muy satisfechas con la técnica empleada. CONCLUSIONES: Una técnica de analgesia multimodal, con un componente de anestésico local y opioide por vía subaracnóidea asociado con AINE venoso produce analgesia pos-operatoria de excelente calidad con pocos efectos colaterales adversos en cirugía videolaparoscópica ginecológica ambulatorial. La elección del AINE no parece importante para la obtención de estos resultados.BACKGROUND AND OBJECTIVES: The quality of postoperative analgesia in patients submitted to outpatient videolaparoscopic gynecologic surgery was evaluated by comparing the effects of intravenous parecoxib and tenoxicam in a double-blind study. METHODS: Participated in this prospective study 60 patients who were randomly divided into two groups. All patients were

  10. 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

    Directory of Open Access Journals (Sweden)

    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

  11. Planificación Neuroquirúrgica con Software Osirix

    Science.gov (United States)

    Jaimovich, Sebastián Gastón; Guevara, Martin; Pampin, Sergio; Jaimovich, Roberto; Gardella, Javier Luis

    2014-01-01

    Introducción: La individualidad anatómica es clave para reducir el trauma quirúrgico y obtener un mejor resultado. Actualmente, el avance en las neuroimágenes ha permitido objetivar esa individualidad anatómica, permitiendo planificar la intervención quirúrgica. Con este objetivo, presentamos nuestra experiencia con el software Osirix. Descripción de la técnica: Se presentan 3 casos ejemplificadores de 40 realizados. Caso 1: Paciente con meningioma de la convexidad parasagital izquierda en área premotora; Caso 2: Paciente con macroadenoma hipofisario, operada previamente por vía transeptoesfenoidal en otra institución con una resección parcial; Caso 3: Paciente con lesiones en pedúnculo cerebeloso medio bilateral. Se realizó la planificación prequirúrgica con el software OsiriX, fusionando y reconstruyendo en 3D las imágenes de TC e IRM, para analizar relaciones anatómicas, medir distancias, coordenadas y trayectorias, entre otras funciones. Discusión: El software OsiriX de acceso libre y gratuito permite al cirujano, mediante la fusión y reconstrucción en 3D de imágenes, analizar la anatomía individual del paciente y planificar de forma rápida, simple, segura y económica cirugías de alta complejidad. En el Caso 1 se pudo analizar las relaciones del tumor con las estructuras adyacentes para minimizar el abordaje. En el Caso 2 permitió comprender la anatomía post-operatoria previa del paciente, para determinar la trayectoria del abordaje transnasal endoscópico y la necesidad de ampliar su exposición, logrando la resección tumoral completa. En el Caso 3 permitió obtener las coordenadas estereotáxicas y trayectoria de una lesión sin representación tomográfica. Conclusión: En casos de no contar con costosos sistemas de neuronavegación o estereotáxia el software OsiriX es una alternativa a la hora de planificar la cirugía, con el objetivo de disminuir el trauma y la morbilidad operatoria. PMID:25165617

  12. 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

    recibieron alguna sustancia analgésica (control. Veinte y dos en el segundo (B que fueron sometidos a la inyección epidural, 20 minutos antes de la incisión quirúrgica, conteniendo 10 mL de marcaína y morfina. En el tercer grupo, y último (C, con 20 pacientes que fueron inyectados con auxilio de un catéter, en el espacio epidural, las mismas drogas del grupo B, por medio de la incisión antes de cerrar la herida operatoria. Los pacientes fueron examinados durante las primeras 24 horas, con auxilio de la escala verbal de dolor. RESULTADOS: los tres grupos fueron comparados según la edad, sexo, nivel y tiempo quirúrgico. Como los datos no obedecieron a una distribución Gausiana, el test paramétrico de Mann-Whitney fue entonces adoptado para análisis estadístico. De esta forma, los valores de la escala verbal de dolor, en todos los intervalos de tiempo fueron significativamente bajos (pOBJECTIVE: To analyze the efficacy of the preemptive analgesia with a method of epidural analgesic administration before and after the surgical painful stimulation, as comparing them. Its role in postoperative pain relief after lumbosacral spinal surgery, by the posterior approach, has not been fully investigated. METHODS: Sixty two patients who underwent microdiscectomy or microdecompression in a single level of the lumbosacral spine were divided into three groups: 20 patients that had not received any analgesic medication in the first one (A (control; 22 that had been submitted to the epidural injection containing 10 mL of marcaína and morphine 20 minutes before the surgical incision in the second one (B. In the third and last group (C, 20 patients received the same drugs of group B, with the aid of a catheter positioned in the epidural space, through the incision before the closing of the surgical wound. The patients were examined during the first 24 hours, with the use of the verbal scale of pain. RESULTS: The three groups were compared concerning age, sex, level and surgical

  13. 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.

  14. Preemptive analgesia: the prevention of neurogenous orofacial pain.

    OpenAIRE

    Foreman, P. A.

    1995-01-01

    Chronic neurogenous pain is often an extremely difficult condition to manage. In the orofacial region, trauma from injury or dental procedures may lead to the development of severe neuralgic pains and major distress to the patient. Clinical and experimental evidence suggests that the use of adequate preemptive regional anesthesia, systemic analgesia, and the avoidance of repeated, painful stimuli may reduce the incidence of this problem.

  15. The Neuroanatomy of Sexual Dimorphism in Opioid Analgesia

    Science.gov (United States)

    2014-04-13

    nociception , morphine antinociception and reproductive indices in male and female rats. Pain 103 (3), 285–302. van Bockstaele, E.J., Aston-Jones, G...Review The neuroanatomy of sexual dimorphism in opioid analgesia Dayna R. Loyd a, Anne Z. Murphy b,⁎ a Pain Management Research Area, United States...online 13 April 2014 Keywords: Pain Periaqueductal gray Morphine Mu opioid receptor The influence of sex has been neglected in clinical studies on pain

  16. [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.

  17. 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.

  18. Clinical study of diffusion hypoxia after nitrous oxide analgesia.

    OpenAIRE

    Quarnstrom, F. C.; Milgrom, P.; Bishop, M. J.; DeRouen, T. A.

    1991-01-01

    In order to estimate the incidence of diffusion hypoxia, arterial oxygen saturation was measured in 104 healthy adult dental patients who were administered nitrous oxide-oxygen analgesia and who did not receive postcessation oxygen. Pretreatment saturation levels as determined by pulse oximetry ranged from 93% to 100%. When the nitrous oxide-oxygen administration ceased, the saturation levels were from 95% to 100%. The mean saturation dropped about 2% over the next 4 min and then stabilized. ...

  19. 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

    Directory of Open Access Journals (Sweden)

    Antônio Mauro Vieira

    2004-08-01

    -adrenérgicos que, cuando administrados por vía peridural, poseen propiedades analgésicas y potencializan los efectos de los anestésicos locales. La actual pesquisa objetiva evaluar la analgesia y la sedación causadas por la clonidina o dexmedetomidina asociadas a la ropivacaína, por vía peridural, en el pós-operatorio de colecistectomía por vía subcostal. MÉTODO: Participaron del estudio aleatorio y duplamente encubierto 40 pacientes, de ambos sexos, con edad variando de 18 a 50 años, peso entre 50 y 100 kg, estado físico ASA I y II, sometidos a colecistectomía por vía subcostal, los cuales fueron distribuidos en dos grupos: clonidina (GC, en que fue administrada clonidina (1 ml = 150 µg asociada a ropivacaína a 0,75% (20 ml por vía peridural; dexmedetomidina (GD, en que fue inyectada dexmedetomidina (2 µg.kg-1 asociada a ropivacaína a 0,75% (20 ml por vía peridural. La analgesia y la sedación fueron observadas 2, 6 y 24 horas después del término de la anestesia. RESULTADOS: Ocurrió sedación después de 2 y 6 horas en ambos grupos, siendo que hubo diferencia estadística significante entre los tiempos de 2 y 6 horas en el grupo dexmedetomidina. Hubo analgesia en ambos grupos, especialmente después de 2 y 6 horas. Fue detectada diferencia estadística significante entre los tiempos de 2, 6 y 24 horas en el grupo dexmedetomidina; en el grupo clonidina esa diferencia estadística significante fue observada entre los tiempos de 2 y 6 horas y entre 2 y 24 horas. CONCLUSIONES: Los resultados permitieron concluir que la clonidina o la dexmedetomidina asociadas a ropivacaína a 0,75% aseguraron analgesia y sedación en los tiempos de observación de 2 y 6 horas después del término de la anestesia, en los pacientes sometidos a la colecistectomia por vía subcostal y que la clonidina promueve analgesia más prolongada.BACKGROUND AND OBJECTIVES: Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate

  20. Effects of block analgesia on attenuating intraoperative stress responses during oral surgery.

    OpenAIRE

    Mamiya, H.; Ichinohe, T.; Kaneko, Y

    1997-01-01

    Surgical intervention affects cardiorespiratory function and deteriorates the homeostatic mechanisms. The aim of this study was to evaluate the effect of block analgesia, which may minimize the intraoperative stress responses during oral surgery. In addition, we evaluated whether block analgesia could lessen the anesthetic requirements. Twenty-eight operative patients were randomly allocated to one of four groups: group 1, 1.3MAC without block analgesia; group 2, 1.6MAC without block analgesi...

  1. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Vivian P. Kamphuis

    2015-01-01

    Full Text Available We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy.

  2. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  3. Effects of hypnotic analgesia and hypnotizability on experimental ischemic pain.

    Science.gov (United States)

    DeBenedittis, G; Panerai, A A; Villamira, M A

    1989-01-01

    Mechanisms of hypnotic analgesia are still poorly understood and conflicting data are reported regarding the underlying neurochemical correlates. The present study was designed to investigate the effects of hypnotically induced analgesia and hypnotizability on experimental ischemic pain, taking into account pain and distress tolerance as well as the neurochemical correlates. 11 high hypnotizable Ss and 10 low hypnotizable Ss, as determined by scores on the Stanford Hypnotic Susceptibility Scale, Form C (Weitzenhoffer & E. R. Hilgard, 1962), were administered an ischemic pain test in both waking and hypnotic conditions. The following variables were measured: (a) pain and distress tolerance, (b) anxiety levels, and (c) plasma concentrations of beta-endorphin and adrenocorticotropic hormone (ACTH). Results confirmed significant increases of pain and distress tolerance during hypnosis as compared to the waking state, with positive correlations between pain and distress relief and hypnotizability. Moreover, a hypnotically induced dissociation between the sensory-discriminative and the affective-motivational dimensions of pain experience was found, but only in high hypnotizable Ss. Hypnotic analgesia was unrelated to anxiety reduction and was not mediated either by endorphins or by ACTH.

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

    DEFF Research Database (Denmark)

    Andersen, Lasse; Husted, Henrik; Otte, Niels Kristian Stahl Kri;

    2008-01-01

    BACKGROUND: High-volume local infiltration analgesia has been shown to be an effective pain treatment after knee replacement, but the role of bandaging to prolong analgesia has not been evaluated. METHODS: 48 patients undergoing fast-track total knee replacement with high-volume (170 mL) 0...... with compression bandage than in those with non-compression bandage and with a similar low use of oxycodone. Mean hospital stay was similar (2.8 days and 3.3 days, respectively). INTERPRETATION: A compression bandage is recommended to improve analgesia after high-volume local infiltration analgesia in total knee...... arthroplasty Udgivelsesdato: 2008/12...

  5. CLINICAL STUDY OF LOW-DOSE KETAMINE ASSOCIATING MORPHINE PATIENT CON-TROL EPIDURAL OR SUBCUTANEOUS ANALGESIA FOR MODERATE AND SEVERE LATE PHASE CANCER PAIN PATIENT%小剂量氯胺酮辅助吗啡硬膜外/皮下自控镇痛用于顽固性中、重度晚期癌痛治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    陈付强; 胡丹; 时飞; 谢平; 王昕; 艾登斌

    2009-01-01

    Objective:To observe the analgesic effects and the side effects of low-dose ketamine associa- ting morphine with patient control epidural analgesia(PCEA)and patient control subcutaneous analgesia (PCSA)for patients late cancer pain.Methods:54 cases late-phase cancer pain patients were divided in to two groups,with low-dose ketamine associating morphine PCEA Was used in the first group and low- dose ketamine associating morphine PCSA in the second group.The VAS(Visual Analogue Scale)Was used to evaluate the pain level,and the side effects in two groups.Results:The pain degrees of the two groups were alleviated significantly,the VAS at every period were no different(P>0.05),the morphine and ketamine dosage in the PCSA group was more than that in the PCEA group.The life satisfactory rate in PCEA group Was higher obviously than that in PCSA group;side effects such as the incidence of nause- a,vomiting,somnolence,itch and urine retention in the PCSA group was higher than those in the PCEA group;the incidence of respiration depression and hallucination was no different between the two groups. Conclusions:Both low-dose ketamine associating morphine with patient-control epidural analgesia (PCEA)and PCSA Call provide patient with safe and effective pain relief for moderate to severe late- phase cancer pain.PCEA is an optimas approach for moderate to severe late-phase concer pain with bet- ter pain relief and less side-effect and PCSA can serve as a complementary analgesia.%目的:观察小剂量氯胺酮辅助吗啡硬膜外或皮下自控镇痛(PCEA/PCSA)用于顽固性中、重度晚期癌痛患者的可行性及止痛效果.方法:选择54例中、重度晚期癌痛患者,均为虽经三阶梯药物治疗方案治疗未能很好地控制疼痛,同时毒副作用较大的患者.按是否可以行硬膜外穿刺置管分成两组,硬膜外自控镇痛(PCEA)组(n=28例)和皮下自控镇痛(PCSA)组(n=26例).采用硬膜外自控镇痛组,镇痛液为200ml,内含吗啡20mg

  6. 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

  7. 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.

  8. Bloqueo femoral tres en uno para cirugía de fractura transtoncantérica de cadera: seguridad y analgesia

    Directory of Open Access Journals (Sweden)

    Walter Rojas-Rivera

    2002-06-01

    Full Text Available Objetivo: Determinar la eficacia del bloqueo femoral tres en uno, como técnica anestésica alternativa en la realización de cirugía de cadera, en pacientes ASA III y IV, así como la valoración postquirurgica de la analgesia. Metodos: se realizó un estudio prospectivo en 12 pacientes, los cuales fueron sometidos a cirugía de cadera, osteosíntesis con pin placa en fractura transtocantérica de fémur, y cuyo estado general fuera clasificado como ASA III o IV. Se le aplicó bloqueo femoral tres en uno y fémoro cutáneo lateral ipsilateral. Se utilizó buvicaína o.25%, lidocaína 2%, llevada a 40 ml de volumen. Resultados: la muestra incluyó siete varones y cinco mujeres. La edad media fue de 68.3 años, con límites entre 37 y 93 años. Los pacientes mostraron asociados diagnósticos de hipertensión arterial, diabetes mellitus, asma, cardiopatía isquémica, disrritmias, encefalopatía. Conclusiones: La estabilidad hemodinámica observada fue excelente, así como la analgesia, durante todo procedimiento y recuperación. La analgesia suplementaria fue mínima y el porcentaje de fallo fue menor del 9%. La gran estabilidad hemodinámica, la técnica sencilla y la alta tasa de efectividad hacen del bloqueo femoral tres en uno, una excelente opción para pacientes ASA III y IV con fractura transtocantérica de cadera, que serán sometidos a cirugía.

  9. Complicaciones e impacto de la cirugía de catarata con lente intraocular en la provincia de Sancti Spíritus.

    Directory of Open Access Journals (Sweden)

    Elsa E. Cabeza Martínez

    2006-10-01

    Full Text Available Se realizó un estudio prospectivo longitudinal en el Hospital Universitario “Camilo Cienfuegos “ de Sancti Spíritus en el periodo comprendido del 1ro de septiembre del 2003 al 31 de agosto del 2004 con el objetivo de conocer las complicaciones trans-operatorias y post-operatorias de la cirugía de catarata así como el impacto de esta nueva técnica a través del grado de satisfacción de la población con los servicios quirúrgicos recibidos. El universo de la investigación estuvo integrado por los 663 pacientes que fueron llevados al quirófano para realizarle la técnica quirúrgica de extracción extracapsular del cristalino con implante de Lente Intraocular. Fue la catarata senil la de mayor incidencia (90,79. La patología ocular previa mas asociada a la catarata en estos pacientes fue la Miopía (5,63%. Las complicaciones trans operatorias fueron las más frecuentes, predominando la ruptura de la cápsula posterior (9,95% acompañada de Vítreo Grado I en el mayor número de casos (86,36%. Las complicaciones post-operatorias inmediatas y mediatas tuvieron una baja incidencia, no así las tardías que ocurrieron en el 7,99% de los casos, el 76,62% de los operados alcanzaron visión por encima de 20/60. El grado de satisfacción de los pacientes operados, con el servicio quirúrgico recibido fue bueno en el 99,8%.

  10. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    P K Dilesh

    2014-01-01

    Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

  11. 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.

  12. 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...

  13. 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.

  14. 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...

  15. Pacientes com seqüelas de poliomielite: a técnica anestésica impõe risco? Pacientes con secuelas de poliomielitis: ¿La técnica anestésica impone algún riesgo? Patients with sequelae of poliomyelitis: does the anesthetic technique impose risks?

    Directory of Open Access Journals (Sweden)

    Daniela Pessini Sobreira Rezende

    2008-06-01

    ésica en el neuroeje en los pacientes con secuela de poliomielitis. Los datos de la literatura son escasos. El objetivo de este estudio fue describir las técnicas anestésicas realizadas en pacientes sometidos a procedimientos quirúrgicos y a eventuales complicaciones. MÉTODO: Estudio retrospectivo de pacientes con secuelas de poliomielitis, sometidos a operaciones, por un período de cinco años. Evaluados los datos demográficos, estado físico (ASA, inicio de la enfermedad, el segmento corporal acometido, diagnóstico de síndrome pos-poliomielitis, operación y anestesia realizadas, analgesia postoperatoria, complicaciones intra y postoperatorias, acompañamiento ambulatorial e incidencia de alteraciones neurológicas. RESULTADOS: Evaluados 123 pacientes sometidos a 162 intervenciones quirúrgicas. La mayoría de los pacientes (n = 82; 66,6% presentaba secuela neurológica en un miembro inferior. La poliomielitis aguda sucedió como promedio a los 2 años y 4 meses de edad. Se sometieron a operaciones ortopédicas 87,7% de los pacientes. La técnica anestésica en un 64,1% de los casos fue por bloqueo en neuroeje. El bloqueo epidural fue el más utilizado. Complicaciones relatadas: punción inadvertida de la duramadre (n = 1; 0,61%, bradicardia (n = 1; 0,61%, hipotensión arterial (n = 2; 1,23%, apnea y rigidez de tórax (n = 1; 0,61% en el intraoperatorio. En el postoperatorio, vómitos (n = 2; 1,23%, retención urinaria (n = 4; 2,46% y síndrome doloroso complejo regional tipo I (n = 2; 1,23%. El acompañamiento ambulatorial fue de 22 meses y no se observó un empeoramiento neurológico. CONCLUSIONES: Los pacientes con secuela de poliomielitis, sometidos al bloqueo del neuroeje no presentaban ninguna complicación o empeoramiento neurológico en el postoperatorio que pudiese ser atribuido a la técnica anestésica.BACKGROUND AND OBJECTIVES: Several questions arise before performing neuro-axis block in patients with sequelae of poliomyelitis. Reports in the

  16. The elusive rat model of conditioned placebo analgesia.

    Science.gov (United States)

    McNabb, Christopher T; White, Michelle M; Harris, Amber L; Fuchs, Perry N

    2014-10-01

    Recent research on human placebo analgesia has suggested the need for rodent models to further elucidate the neural substrates of the placebo effect. This series of 3 experiments therefore was performed in an attempt to develop a model of placebo analgesia in rats. In each study, female Sprague-Dawley rats received an L5 spinal nerve ligation to induce a neuropathic pain condition. Each rat then underwent a 4-day conditioning procedure in which an active analgesic drug or its vehicle (unconditioned stimulus) was associated with the following cues (conditioned stimuli): novel testing room (environmental), vanilla scent cue (olfactory), dim incandescent lighting (visual), restraint procedure/injection (tactile), and time of day and injection-test latency (temporal). The analgesics for each experiment were as follows: Experiment 1 used 90 mg/kg gabapentin, experiment 2 used 3mg/kg loperamide hydrochloride, and experiment 3 used 6 mg/kg morphine sulfate. On the following test day, half of the animals received the opposite treatment, resulting in 4 conditioning manipulations: drug/drug, drug/vehicle, vehicle/drug, and vehicle/vehicle. Nociceptive thresholds were assessed with the mechanical paw withdrawal threshold test each day after the conditioning procedure. In all 3 experiments, no significant differences were detected on test day between control and placebo groups, indicating a lack of a conditioned placebo analgesic response. Our results contrast with prior research that implies the existence of a reliable and robust response to placebo treatment. We conclude that placebo analgesia in rats is not particularly robust and that it is difficult to achieve using conventional procedures and proper experimental design.

  17. The impact of patients controlled analgesia undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    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.

  18. INTRAVENOUS DEXMEDETOMIDINE FOR LABOUR ANALGESIA IN WOMEN WITH PREECLAMPSIA

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    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

  19. 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.

  20. 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

  1. 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.

  2. Opioid and nonopioid interactions in two forms of stress-induced analgesia.

    Science.gov (United States)

    Grisel, J E; Fleshner, M; Watkins, L R; Maier, S F

    1993-05-01

    Stressful environmental events activate endogenous mechanisms of pain inhibition. Under some circumstances the analgesia is blocked by naloxone/naltrexone ("opioid"), while under others it is not ("nonopioid"). The existence of these two categories of analgesia leads to the question of how they are related. In a collateral inhibition model proposed by Kirshgessner, Bodnar, and Pasternak (1982), opiate and nonopiate mechanisms were viewed as acting in a mutually inhibitory fashion. In the present experiments, rats were exposed to either of two environmental stressors that produce a nonopioid stress-induced analgesia (SIA) following injections of the opiate antagonist naltrexone or agonist morphine. In the presence of naltrexone, SIA produced by either cold water swim (CWS) or social defeat was enhanced. These same SIAs were found to attenuate the analgesic effect of morphine, demonstrating that an activation of opioid systems can inhibit nonopioid analgesias. These results support an inhibitory interaction of opioid and nonopioid mechanisms in some forms of stress-induced analgesia.

  3. [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.

  4. [High thoracic epidural analgesia in the postoperative period after correction of congenital heart defects in children].

    Science.gov (United States)

    Slin'ko, S K

    1999-01-01

    The effects and side effects of thoracic epidural analgesia on the respiratory response, awakening time, and cooperation with nurses were studied. Forty children received epidural analgesia after open-heart surgery. Lidocaine was injected in a dose of 1.5-2 mg/kg every 1.5-2 h. Controls (16 pts) received intravenous fentanyl + diazepam analgesia. Respiratory response and awakening were significantly earlier (p < 0.001) in the epidural group. Cooperation with nurses was much better in this group, too. No side effects were observed in the epidural group. Therefore, thoracic epidural analgesia is a safe and effective method of postoperative analgesia for children subjected to open-heart surgery.

  5. 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.

  6. 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.

  7. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  8. Estudo comparativo entre concentrações de bupivacaína a 0,125% e a 0,25% associada ao fentanil para analgesia de parto por via peridural Estudio comparativo entre concentraciones de bupivacaína a 0,125% y a 0,25% asociada al fentanil para analgesia de parto por vía peridural Comparison between 0.125% and 0.25% bupivacaine associated to fentanyl for epidural labor analgesia

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    Marcos Emanuel Wortmann Gomes

    2004-08-01

    (0,25% [n = 23] ó 0,125% [n = 28]. Para la mensuración de la analgesia, fue utilizada la escala numérica de dolor, y para la evaluación del bloqueo motor, la escala de Bromage. Para la comparación de las medias, fue utilizado el teste t de Student, y, para la comparación de las proporciones, el teste Qui-cuadrado, con p BACKGROUND AND OBJECTIVES: Epidural analgesia aims at decreasing or even abolishing maternal suffering during labor. It is considered a safe and effective method for pain relief. This study aimed at comparing two bupivacaine concentrations (0.25% and 0.125% associated to fentanyl in epidural labor analgesia to determine its efficacy on pain relief and its effect on motor block. We have also observed the influence of these two concentrations on labor duration, fetal outcome and maternal satisfaction. METHODS: Participated in this prospective and double blind study 51 primiparous women who were randomized to receive one out of two bupivacaine concentrations for epidural labor analgesia (0.25% [n = 23] or 0.125% [n = 28]. Analgesia was measured using a numeric pain scale, and motor block was verified using Bromage scale. Means were compared using Student's t test, while proportions were compared using Qui-square test, with p < 0.05. RESULTS: There has been no statistical difference in pain, degree of motor block and fetal outcome between groups. Cesarean delivery rate was statistically higher in the group receiving 0.25% bupivacaine (p < 0.05. Lower concentration group patients were more satisfied with the procedure (p < 0.01. CONCLUSIONS: The association of fentanyl and 0.125% bupivacaine proved to be more beneficial as compared to 0.25% concentration. With this dose, there has been a lower incidence of adverse effects without compromising analgesia, and yet a higher rate of maternal satisfaction.

  9. Update on epidural analgesia during labor and delivery.

    Science.gov (United States)

    Lurie, S; Priscu, V

    1993-05-01

    Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.

  10. CLINICAL OBSERVATION ON ACUPOINT INJECTION ANALGESIA FOR ARTIFICIAL ABORTION

    Institute of Scientific and Technical Information of China (English)

    马民玉; 李红; 等

    2000-01-01

    In the present study,the effect of acupoint injection analgesia for artificial abortion Was observed.40patients were divided at random into2groups:Acupoint injection group(n=20)and control group(n=20).In the former group,bilateral Zusanli(ST36)and Sanyinjiao(SP6)were selected.1-1.5ml diluted analgesic solution was injected into each acupoint respectively about5-10minutes before operation.The blood pressure(BP)and heart rate(HR)of the patients were all moni-tored before and during operation.Results showed that the effective rates of analgesia for uterus aspira-tion and dilation of the uterine cervix were90percent and 85percent respectively.Patients'BP and HR during operation were all stable as compared with those before operation(P>0.05).It indicates that this method has a better effect in relieving abdominalgia and preventing nausea and vomiting dur-ing artificial abortion.It can be developed and used in clinic.

  11. 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

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    Isabel C.F. Salem

    2007-04-01

    utilizadas, administrado por via subaracnóidea ou peridural, associado aos anestésicos locais, determinou similaridade na duração do trabalho de parto após analgesia e no Apgar dos recém-nascidos. A sedação foi o efeito adverso mais freqüente nas pacientes que receberam o opióide pela via peridural.JUSTIFICATIVA Y OBJETIVOS: La asociación del opioide con el anestésico local mejora la calidad de la analgesia de parto y reduce el riesgo de toxicidad sistémica por el anestésico local. Los opioides, sin embargo, pueden determinar efectos colaterales. El objetivo de esta investigación fue comparar los efectos adversos determinados por el sufentanil, administrado por vía subaracnoidea, asociado a la bupivacaína, con aquel determinado por el sufentanil por vía peridural, asociado a la ropivacaína, en las dosis utilizadas en el Servicio de Anestesia, en embarazadas sometidas a la analgesia de parto. MÉTODO: Participaron del estudio 60 pacientes, estado físico ASA I y II, con edad entre los 15 y los 42 años, con embarazo en tiempo y fetos saludables, sometidas a la analgesia de parto. Se distribuyeron aleatoriamente en de los grupos: G1 Doble bloqueo bupivacaína a 0,5% (2,5 mg y sufentanil (5 µg por vía subaracnoidea, G2 Peridural ropivacaína a 0,2% (20 mg y sufentanil (10 µg por vía peridural. Para dosis complementarias fue administrada ropivacaína a 0,2% (12 mg y para resolución del parto, ropivacaína a 1% (50 mg. Las pacientes se evaluaron después de la analgesia (M1 con relación a la hipotensión arterial, bradicardia materna, prurito, náusea, vómito, depresión respiratoria y sedación. En el postoperatorio (M2, en cuanto a la presencia de náusea, vómito, prurito, sedación, retención urinaria y dolor. Los recién nacidos se evaluaron por el índice de Apgar. Para análisis estadístico, se utilizaron la prueba t de Student, Mann-Whitney y Qui-cuadrado. RESULTADOS: Los grupos fueron similares con relación a la edad, al peso, a la altura, a

  12. Analgesia pós-operatória em pacientes pediátricos: estudo comparativo entre anestésico local, opióides e antiinflamatório não esteróide Analgesia pós-operatoria en pacientes pediátricos: estudio comparativo entre anestésico local, opioides y antiinflamatorio no esteróide Postoperative analgesia in pediatric patients: comparative study among local anesthetics, opioids and non-steroidal anti-inflammatory drugs

    Directory of Open Access Journals (Sweden)

    Miriam Seligman Menezes

    2002-04-01

    ças relevantes e apresentaram maior incidência de efeitos colaterais. O diclofenaco por via retal não se mostrou efetivo como analgésico único quando comparado às outras técnicas.JUSTIFICATIVA Y OBJETIVOS: El tratamiento del dolor pós-operatoria en niños ha merecido atención especial en las últimas décadas. El propósito de este estudio fue analizar la analgesia pós-operatoria de niños en lo que se relaciona a la calidad y a la duración de la analgesia, la confianzabilidad de los métodos de evaluación y la incidencia de efectos colaterales decurrentes de las diferentes técnicas de analgesia utilizadas. MÉTODO: Participaron del estudio 100 niños con edades entre 2 y 12 anos distribuidos en 5 grupos de 20 niños cada, que recibieron, luego después la inducción de la anestesia, los siguientes tratamientos de analgesia: grupo B, bupivacaína 0,25%, con vasoconstritor, 0,5 a 1 ml.kg-1; grupo F, fentanil, 1,5 µg.kg-1; grupo M, morfina, 30 µg.kg-1, grupo S, sufentanil, 0,3 µg.kg-1, todos por vía peridural caudal y el grupo D, que recibió diclofenaco potásico (1 mg.kg-1 por vía retal. El dolor fue evaluada por 2 métodos distintos: uno predominantemente comportamental, objetivo y el otro de auto-evaluación, subjetivo, durante las primeras 4 horas y a partir de este momento hasta la 24ª hora. Fueron observados efectos colaterales y fueron tratados. RESULTADOS: En las primeras 4 horas los pacientes de los grupos B, F, M y S presentaron comportamientos semejantes, con mínimas necesidades de analgesia complementar. En las 20 horas restantes el mayor tiempo de analgesia fue observado en el grupo S, no divergiendo del grupo F y M, más siendo significativamente superior al tiempo de los grupos B y D. Diclofenaco rectal no promovió alivio efectivo del dolor. Mayor incidencia de efectos colaterales ocurrió en el grupo M que no divergió del grupo S, más fue significativamente superior a los grupos F, B y D. Hubo correlación positiva y significativa entre los

  13. 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.

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

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    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

  15. Remifentalino intravenoso mediante infusor elastomerico frente a meperidina intramuscular: Estudio comparativo en analgesia obstetrica Intravenous remifentanil delivered through an elastomeric device versus intramuscular meperidine comparative study for obstetric analgesia

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    E. Calderón

    2006-10-01

    Full Text Available Objetivos: Evaluar la eficacia y seguridad de remifentanilo administrado mediante infusor elastomérico con PCA iv en analgesia obstétrica comparado con meperidina intramuscular en parturientas con contraindicación para analgesia epidural. Material y Método: Se seleccionaron aletoriamente 24 parturientas, se asoció infusor elastomérico Baxter® con 250 ml de suero fisiológico con 2,5 mg de remifentanilo y un ritmo de 12 ml·h ¹, lo que supone una infusión media de 0,025 μg·kg-1·min-1 de remifentanilo, permitiendo la administración de bolos de 5 ml con un tiempo de cierre de 30 minutos (Grupo R o 1 mg·kg¹ de meperidina y 2,5 mg de haloperidol (Grupo M vía intramuscular cada 4 h. Valoramos la intensidad del dolor cada 30 min mediante una escala analógica visual (EVA, tiempo de infusión, bolos administrados, el nivel de sedación mediante escala del estado de alerta y sedación evaluada por el observador (OAA/S, efectos adversos y el test de Apgar del recién nacido al minuto y a los 5 min. Resultados: No hubo diferencias en los datos antropométricos de ambos grupos. La duración media de la infusión en el grupo R fue de 280 ± 55 min y las necesidades de bolos de rescate de 1,2 ± 1,5. La dosis media de meperidina intramuscular en el grupo M fue de 120 ± 25 mg. La intensidad del dolor durante el parto fue significativamente menor en el grupo R durante todo el periodo de dilatación y expulsivo (pObjectives: To evaluate the effectiveness and security of remifentanil administered by means of elastomeric infusor with PCA IV compared obstetrical analgesia with intramuscular meperidine in obstetric patients with contraindication for epidural analgesia, Material and Method: 24 patients were randomized, an elastomeric infusor Baxter® with a capacity of 250 ml was filled with 2.5 mg of remifentanil and a 12 mililiter·h-1, was satarted, (average infusion of 0.025·kg-1·min-1 of remifentanil, and boluses of 5 ml with a time of closing

  16. Estimulação elétrica nervosa transcutânea no alívio da dor pós-operatória relacionada com procedimentos fisioterapêuticos em pacientes submetidos a intervenções cirúrgicas abdominais Estimulación eléctrica nerviosa transcutánea no alivio del dolor postoperatorio relacionado con los procedimientos fisioterapéuticos en pacientes sometidos a intervenciones quirúrgicas abdominales Transcutaneous electrical nerve stimulation in the relief of pain related to physical therapy after abdominal surgery

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    Rodrigo Marques Tonella

    2006-12-01

    estudiada como método facilitador de la fisioterapia postoperatoria. El objetivo del estudio fue el de verificar la eficacia de la TENS en el alivio del dolor relacionado a la fisioterapia postoperatoria en pacientes sometidos a intervenciones quirúrgicas abdominales. MÉTODO: Se realizó un estudio clínico, prospectivo, con distribución aleatoria, incluyendo 48 pacientes en el 1º día de postoperatorio, que presentaban un puntaje de dolor > 3 puntos en la escala visual analógica (VAS, divididos en tres grupos: Grupo Control: con rutina analgésica habitual, sin TENS y con fisioterapia; Grupo Estudio, recibiendo rutina analgésica habitual más TENS, y fisioterapia; Grupo Contraste-Placebo, recibiendo rutina analgésica habitual, fisioterapia y TENS desvinculada. Se presentó a los pacientes una escala visual analógica de dolor antes (M1, después de la TENS (M2 y después de la fisioterapia (M3 - tos, incentivador respiratorio, cambio de decúbito lateral y sentado - cuantificando la efectividad de la analgesia. El tiempo de electroestimulación fue de 30 minutos. RESULTADOS: Hubo un alivio significativo del dolor en el Grupo Estudio, comparándolo con los tres grupos, apenas para el procedimiento tos, en el M3 (p = 0,015. Dentro de ese grupo hubo una disminución significativa del dolor para tos (p = 0,003 [M1 versus M3]; para decúbito lateral (p = 0,025, sentarse (p = 0,001 y utilizar el incentivador inspiratorio (p = 0,017 [M1 versus M2]; y al cambiar para decúbito lateral (p = 0,03 y sentarse (p = 0,001 [M1xM3]. No hobo diferencia significativa en el Grupo Contraste Placebo. CONCLUSIONES: Hubo disminución del dolor en el Grupo Estudio, en algunos momentos y parámetros. Estudios adicionales se hacen necesarios, ya que la utilización de la TENS está indicada apenas como coadyuvante en el control del dolor postoperatorio.BACKGROUND AND OBJECTIVES: There are few studies on transcutaneous electrical stimulation (TENS as an adjunct to postoperative physical

  17. Imaging-guided hyperstimulation analgesia in low back pain

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    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

  18. Intravenous sub-anesthetic ketamine for perioperative analgesia.

    Science.gov (United States)

    Gorlin, Andrew W; Rosenfeld, David M; Ramakrishna, Harish

    2016-01-01

    Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  19. Intravenous sub-anesthetic ketamine for perioperative analgesia

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    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

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

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    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.

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

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    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

  2. Gravity of injury and analgesia in patients who suffered traffic accidents Gravedad de la lesión y analgesia en pacientes que sufrieron accidentes de tránsito Gravidade da lesão e analgesia em pacientes que sofreram acidentes de transporte

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    Ana Maria Calil

    2008-01-01

    Full Text Available OBJECTIVE: Identifying the frequency and gravity of injuries in patients who suffered accidents in traffic and the analgesic drugs utilized. METHODS: Retrospective study, with a sample of 200 medical records of patients admitted to the emergency services of a reference hospital for trauma care. The gravity of the injuries was characterized by anatomic gravity rates and the analgesic therapy was based on the World Health Organization's Analgesic Ladder. RESULTS: The main findings pointed to injuries in limbs, head, face and outer surface as the most frequent, and, in 85% of the cases, gravity was equal or lower than 3; As for analgesia, it was verified that 46;6% of the patients received dipyrone and paracetamol. Among the opioids, meperidine was used in 10.4% of the cases. CONCLUSION: The gravity of most injuries was equal or lower to 3, indicating injuries of light, moderate and serious gravity, located especially in four body regions; regarding analgesia, dipyrone was shown to be the most commonly-used drug and a low use of opioids was verified.OBJETIVOS: Identificar la frecuencia y gravedad de las lesiones en accidentados de tránsito y las drogas analgésicas utilizadas. MÉTODOS: Se trata de un estudio retrospectivo, con muestra de 200 historias clínicas de pacientes internados en el servicio de emergencia de un Hospital de referencia para la atención al trauma. La gravedad de las lesiones fue caracterizada por índices de gravedad anatómicos y la terapéutica analgésica con base en la Escalera Analgésica de la Organización Mundial de la Salud. RESULTADOS: Los principales hallazgos apuntaron las lesiones en miembros, cabeza, cara y superficie externa como las más frecuentes, y en un 85% de los casos con gravedad menor o igual a 3; en cuanto a la analgesia se verificó que el 46,6% de los pacientes recibieron dipirona y paracetamol, entre los opioides se destacó la meperidina con el 10,4%. CONCLUSIÓN: La mayoría de las lesiones

  3. [Eutopic parturition: psychoprophylaxis or extradural analgesia. Influence on the endocrine response].

    Science.gov (United States)

    Carrasco, M S; Iglesias, J; Freire, J; Martín, M L; Marín Santana, A; Cobo, I; García Rendón, A

    1989-01-01

    Prolactin, ACTH, cortisol and HGH levels have been studied on 30 pregnant women in three different periods: during the labour, at the delivery and 24 hours later. They were divided into 3 groups depending on the analgesia: I) no analgesia (n = 10); II) psychoprophylaxis (n = 10), and III) extradural analgesia (n = 10). Prolactin levels increased during delivery and 24 hours later. A significant increase of ACTH levels (p less than 0.01) was observed during the delivery in the 3 groups even though they were under hasal values 24 hours later. Cortisol increased 38% (p less than 0.01) and 52% (p less than 0.02) in II and III groups, respectively during the delivery. No difference was found with HGH. Our results suggest that endocrine response modified by labour and delivery doesn't change with different analgesia techniques.

  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

    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...

  5. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

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    Elham M. El-Feky

    2015-04-01

    Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

  6. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

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    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  7. 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...

  8. Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

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    Patrícia Gomes da Silva

    2011-12-01

    Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

  9. Continuous postoperative analgesia via quadratus lumborum block - an alternative to transversus abdominis plane block.

    Science.gov (United States)

    Visoiu, Mihaela; Yakovleva, Nataliya

    2013-10-01

    Different transversus abdominis plane blocks techniques cause variations in postoperative analgesia characteristics. We report the use of unilateral quadratus lumborum catheter for analgesia following colostomy closure. The catheter was placed under direct ultrasound visualization and had good outcomes: low pain scores and minimal use of rescue analgesic medication. No complications were reported in this pediatric patient. More studies are needed to evaluate the effectiveness and safety of this regional anesthesia technique.

  10. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient.

    Science.gov (United States)

    Chakraborty, Arunangshu; Goswami, Jyotsna; Patro, Viplab

    2015-02-01

    Quadratus lumborum block is a recently introduced variation of transversus abdominis plane block. In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic.

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

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    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

  12. [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.

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

    OpenAIRE

    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 via non-opioidergic pathways are under investigation and are aimed at reversal of opioid-induced respiratory depression without compromising analgesia. 2. Mathematical modelling of the non-steady s...

  14. Analgesia for Older Adults with Abdominal or Back Pain in the Emergency Department

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    Mills, Angela M

    2011-02-01

    Full Text Available Objective: To determine the association between age and analgesia for emergency department (ED patients with abdominal or back pain.Methods: Using a fully electronic medical record, we performed a retrospective cohort study of adults presenting with abdominal or back pain to two urban EDs. To assess differences in analgesia administration and time to analgesia between age groups, we used chi-square and Kruskal-Wallis test respectively. To adjust for potential confounders, we used a generalized linear model with log link and Gaussian error.Results: Of 24,752 subjects (mean age 42 years, 65% female, 69% black, mean triage pain score 7.5, the majority (76% had abdominal pain and 61% received analgesia. The ≥80 years group (n=722; 3%, compared to the 65-79 years group (n=2,080; 8% and to the (n=21,950; 89%, was more often female (71 vs. 61 vs. 65%, black (72 vs. 65 vs. 69%, and had a lower mean pain score (6.6 vs. 7.1 vs. 7.6. Both older groups were less likely to receive any analgesia (48 vs. 59 vs. 62%, p<0.0001 and the oldest group less likely to receive opiates (35 vs. 47 vs. 44%, p<0.0001. Of those who received analgesia, both older groups waited longer for their medication (123 vs. 113 vs. 94 minutes; p<0.0001. After controlling for potential confounders, patients ≥80 years were 17% less likely than the <65 years group to receive analgesia (95% CI 14-20%.Conclusion: Older adults who present to the ED for abdominal or back pain are less likely to receive analgesia and wait significantly longer for pain medication compared to younger adults. [West J Emerg Med. 2011;12(1;43-50.

  15. ANAESTHESIA, POSTOPERATIVE ANALGESIA AND EARLY REHABILITATION FOR UPPER EXTREMITY BONE AND MAJOR JOINTS SURGERY

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    A. V. Kurnosov

    2011-01-01

    Full Text Available A new method was developed to perform prolonged brachial plexus block with almost 100% effectiveness. It was also shown in 44 patients to be 33 % safer for local complications and 11,3 % safer for general complications than common used supraclavicular Winnie block (42 patients in control group, received opiates and NSAID for post-operative analgesia. This new method of analgesia allows effective rehabilitation after elbow arthroplasty to be started on the first day after the surgery.

  16. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status

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    Narmada P Gupta

    2008-01-01

    Conclusion: The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.

  17. 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.

  18. 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.

  19. Clonidine as an adjuvant for propranolol enhances its effect on infiltrative cutaneous analgesia in rats.

    Science.gov (United States)

    Hung, Ching-Hsia; Chiu, Chong-Chi; Liu, Kuo-Sheng; Wang, Jhi-Joung; Chen, Yu-Wen

    2016-03-11

    Clonidine prolongs duration of analgesia when used as an adjunct to local anesthetics for infiltrative cutaneous analgesia, and propranolol produces local anesthesia. The purpose of the experiment was to evaluate clonidine as an adjuvant for propranolol on the quality and duration of cutaneous analgesia. A rat model of cutaneous trunci muscle reflex (CTMR) in response to local skin pinprick was employed to evaluate the cutaneous analgesic effect of propranolol combined with clonidine. The long-lasting local anesthetic bupivacaine was used as control. Cutaneous analgesia elicited by propranolol and bupivacaine was dose-dependent, and both propranolol (9.0μmol) and bupivacaine (1.8μmol) produced 100% nociceptive blockade. On an 50% effective dose (ED50) basis, the relative potency was bupivacaine [0.48 (0.42-0.55) μmol] greater than propranolol [2.27 (1.98-2.54) μmol] (ppropranolol or bupivacaine) at ED50 or ED95 increased the potency and extended the duration at producing cutaneous analgesia. The resulting data demonstrated that propranolol is less potent than bupivacaine as an infiltrative anesthetic. Clonidine as an adjuvant for propranolol or bupivacaine has a significant peripheral action in increasing the depth and duration of action on infiltrative cutaneous analgesia.

  20. Analgesia, sedação e relaxamento neuromuscular no doente ventilado em cuidados intensivos cardíacos: parte I: analgesia

    OpenAIRE

    Vilela, H; D. Ferreira

    2006-01-01

    Neste artigo são revistos aspectos clínicos relevantes relacionados com a sedação, analgesia e relaxamento neuromuscular em Cuidados Intensivos Cardíacos, incluindo métodos de monitorização e opções terapêuticas disponíveis. São ainda abordadas as implicações fisiopatológicas da dor, agitação, ansiedade e delírio no doente ventilado. Apesar de terem sido publicadas recentemente normas de orientação para sedação, analgesia e relaxamento neuromuscular em Cuidados Intensi...

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

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    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.

  2. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8% e em dois pacientes na apófise xifóide (3,2%. Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p JUSTIFICATIVA Y OBJETIVOS: No obstante el bloqueo pleural haber sido convertido casi en una panacea analgésica, fueron publicados resultados contradictorios. El objetivo de este estudio fue observar el desempeño analgésico y espirométrico de las funciones pulmonares en el pós-operatorio inmediato de 21 pacientes con el bloqueo pleural bilateral en laparotomias medianas de urgencia. M

  3. 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

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

    Science.gov (United States)

    Valente, A.; Frassanito, L.; Natale, L.; Draisci, G.

    2012-01-01

    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. PMID:22844625

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

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    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.

  6. Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers.

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    Collis, R E; Baxandall, M L; Srikantharajah, I D; Edge, G; Kadim, M Y; Morgan, B M

    1994-04-01

    Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). The initial dose was given into the subarachnoid space and analgesia maintained via an epidural catheter. A subarachnoid injection of 2.5 mg bupivacaine and 25 mug fentanyl was successfully given in 268 women (89.3%). Completely pain-free contractions within 3 min of this injection occurred in 195 women (65%) and in all 300 within 20 min and there was no associated motor block in 291 (97%). 141 women chose to stand, walk or sit in a rocking chair at some time during labour. Only 38 women (12.6%) were immobile during the first stage of labour. Analgesia was maintained via the epidural catheter with bolus doses of 10-15 ml of 0.1% bupivacaine and 0.0002% fentanyl. The mean bupivacaine requirement was 9.5 mg/h throughout the entire duration of analgesia. The incidence of post lumbar puncture headache was 2.3%. Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.

  7. Differential effects of experimental central sensitization on the time-course and magnitude of offset analgesia.

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    Martucci, Katherine T; Yelle, Marc D; Coghill, Robert C

    2012-02-01

    Pain perception is temporally altered during states of chronic pain and acute central sensitization; however, the mechanisms contributing to temporal processing of nociceptive information remain poorly understood. Offset analgesia is a phenomenon that reflects the presence of temporal contrast mechanisms for nociceptive information and can provide an end point to study temporal aspects of pain processing. In order to investigate whether offset analgesia is disrupted during sensitized states, 23 healthy volunteers provided real-time continuous visual analogue scale responses to noxious heat stimuli that evoke offset analgesia. Responses to these stimuli were evaluated during capsaicin-heat sensitization (45°C stimulus, capsaicin cream 0.1%) and heat-only sensitization (40°C stimulus, placebo cream). Capsaicin-heat sensitization produced significantly larger regions of secondary mechanical allodynia compared to heat-only sensitization. Although areas of mechanical allodynia were positively related to individual differences in heat pain sensitivity, this relationship was altered at later time points after capsaicin-heat sensitization. Heat hyperalgesia was observed in the secondary region following both capsaicin-heat and heat-only sensitization. Increased latencies to maximal offset analgesia and prolonged aftersensations were observed only in the primary regions directly treated by capsaicin-heat or heat alone. However, contrary to the hypothesis that offset analgesia would be reduced following capsaicin-heat sensitization, the magnitude of offset analgesia remained remarkably intact after both capsaicin-heat and heat-only sensitization in zones of both primary and secondary mechanical allodynia. These data indicate that offset analgesia is a robust phenomenon and engages mechanisms that interact minimally with those supporting acute central sensitization.

  8. 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

  9. 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.

  10. Bloqueo femoral tres en uno para cirugía de fractura transtoncantérica de cadera: seguridad y analgesia

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    Walter Rojas-Rivera

    2002-06-01

    Full Text Available Objetivo: Determinar la eficacia del bloqueo femoral tres en uno, como técnica anestésica alternativa en la realización de cirugía de cadera, en pacientes ASA III y IV, así como la valoración postquirurgica de la analgesia. Metodos: se realizó un estudio prospectivo en 12 pacientes, los cuales fueron sometidos a cirugía de cadera, osteosíntesis con pin placa en fractura transtocantérica de fémur, y cuyo estado general fuera clasificado como ASA III o IV. Se le aplicó bloqueo femoral tres en uno y fémoro cutáneo lateral ipsilateral. Se utilizó buvicaína o.25%, lidocaína 2%, llevada a 40 ml de volumen. Resultados: la muestra incluyó siete varones y cinco mujeres. La edad media fue de 68.3 años, con límites entre 37 y 93 años. Los pacientes mostraron asociados diagnósticos de hipertensión arterial, diabetes mellitus, asma, cardiopatía isquémica, disrritmias, encefalopatía. Conclusiones: La estabilidad hemodinámica observada fue excelente, así como la analgesia, durante todo procedimiento y recuperación. La analgesia suplementaria fue mínima y el porcentaje de fallo fue menor del 9%. La gran estabilidad hemodinámica, la técnica sencilla y la alta tasa de efectividad hacen del bloqueo femoral tres en uno, una excelente opción para pacientes ASA III y IV con fractura transtocantérica de cadera, que serán sometidos a cirugía.Twelve three in one femoral blocks were done for osteosynthesis with pin plate in transtrochanteric hip fracture in patients ASA III and ASA IV. It was used bupivacain 0,25% and lidocain 2% to a 40 ml volume. Observed hemodynamic stability was excellent, thus analgesic during the procedure and recover. Supplementary analgesic was minimal and the fail rate was less than 9%. Great hemodynamic stability, the simplicity of the procedure and the high efectiveness rate, made of the three in one femoral block an excellent choice for patients ASA III and ASA IV with transtrochanteric hip fracture that

  11. Anestesia subaracnoidea para cesariana em paciente com derivação ventriculoperitoneal: relato de caso Anestesia subaracnoidea para cesárea en paciente con derivación ventriculoperitoneal: relato de caso Subarachnoid blockade for cesarean section in a patient with ventriculoperitoneal shunt: case report

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    Alexandre Palmeira Goulart

    2009-08-01

    . Actualmente no existe un consenso en la literatura sobre la técnica anestésica de elección en esos casos. El objetivo de este relato, fue describir el caso de un paciente con DVP sometida a cesárea bajo anestesia subaracnoidea. RELATO DEL CASO: Paciente de 28 años, secundípara, con un parto anterior sin historial de aborto, de término, prenatal sin intercurrencias, en trabajo de parto hacía ya cinco horas, y una cesárea realizada hace siete años. Evoluciona con sufrimiento fetal agudo, indicada una cesárea de emergencia. Portadora DVP hace cinco años, debido a la hipertensión intracraneal (sic de etiología desconocida. Examen neurológico normal. Se sometió a la anestesia subaracnoidea con bupivacaína a 0,5% pesada 15 mg y morfina 80 ¼g. El nacimiento fetal fue con Apgar 8 (1 minuto y 10 (5 minutos después del nacimiento. El alta fue concedida después de dos días en excelente condición clínica. CONCLUSIONES: El abordaje anestésico de pacientes obstétricas con DVP es complejo, y deben ser comparados el riesgo y el beneficio de las técnicas en el momento y en las circunstancias de la indicación. El bloqueo del neuro-eje ha sido relatado con éxito en las portadoras de enfermedades neurológicas. En cuanto a la DVP, no existe en la literatura ninguna contraindicación formal para el bloqueo. Los casos deben ser individualizados. En este relato frente a la emergencia obstétrica y el cuadro neurológico vigente, se optó por el bloqueo en el neuro-eje. La técnica proporcionó un adecuado manejo de la vía aérea, una buena condición materno-fetal y una analgesia postoperatoria. La evolución fue favorable sin alteraciones neurológicas provenientes de la técnica escogida.BACKGROUND AND OBJECTIVES: Patients with ventriculoperitoneal shunt (VPS represent an additional concern when neuroaxis block is indicated, especially in obstetrics. Currently, a consensus on the anesthetic technique of choice in those cases does not exist in the literature. The

  12. 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.

  13. Kin interaction enhances morphine analgesia in male mice.

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    D'Amato, F R

    1998-07-01

    The additive effect of social and pharmacological treatments was evaluated in pairs of male mice. Ineffective and effective doses of morphine (2.5 and 5.0 mg/kg, i.p.) were tested on pain threshold in dyads of males at different times after pair formation and drug treatment. During the second hour of social interaction after reunion, saline-injected adult sibling male mice showed a decrease in nociception as measured by the tail-flick test. Pairs of unrelated, unfamiliar control mice showed no changes in pain sensitivity during a 2-h social session. An ineffective dose of 2.5 mg/kg of morphine in non-sibling males, significantly increased tail-flick latencies in sibling pairs, before the effect of the social environment (sibling) reached statistical significance. The higher dose of morphine (5.0 mg/kg) produced analgesia in sibling as well as in non-sibling males, but the effect in the latter disappeared 60 min after drug treatment, whereas siblings were still analgesic. These results indicate that an ineffective dose of morphine, combined with the activation of the endogenous opioid system by social factors, can affect nociception.

  14. 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.

  15. Meditative analgesia: the current state of the field.

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    Grant, Joshua A

    2014-01-01

    Since the first demonstrations that mindfulness-based therapies could have a positive influence on chronic pain patients, numerous studies have been conducted with healthy individuals in an attempt to understand meditative analgesia. This review focuses explicitly on experimental pain studies of meditation and attempts to draw preliminary conclusions based on the work completed in this new field over the past 6 years. Dividing meditative practices into the broad categories of focused attention (FA) and open monitoring (OM) techniques allowed several patterns to emerge. The majority of evidence for FA practices suggests they are not particularly effective in reducing pain. OM, on the other hand, seems to influence both sensory and affective pain ratings depending on the tradition or on whether the practitioners were meditating. The neural pattern underlying pain modulation during OM suggests meditators actively focus on the noxious stimulation while inhibiting other mental processes, consistent with descriptions of mindfulness. A preliminary model is presented for explaining the influence of mindfulness practice on pain. Finally, the potential analgesic effect of the currently unexplored technique of compassion meditation is discussed.

  16. RESULTS OF THE MEGAVERTEBRATE ANALGESIA SURVEY: ELEPHANTS AND RHINO.

    Science.gov (United States)

    Kottwitz, Jack; Boothe, Matthew; Harmon, Roy; Citino, Scott B; Zuba, Jeffery R; Boothe, Dawn M

    2016-03-01

    An online survey utilizing Survey Monkey linked through the American Association of Zoo Veterinarians listserve examined current practices in megavertebrate analgesia. Data collected included drugs administered, dosing regimens, ease of administration, efficacy, and adverse events. Fifty-nine facilities (38 housing elephants, 33 housing rhinoceroses) responded. All facilities administered nonsteroidal anti-inflammatory drugs (NSAIDs), with phenylbutazone (0.25-10 mg/kg) and flunixin meglumine (0.2-4 mg/kg) being most common. Efficacy was reported as "good" to "excellent" for these medications. Opioids were administered to elephants (11 of 38) and rhinoceroses (7 of 33), with tramadol (0.5-3.0 mg/kg) and butorphanol (0.05-1.0 mg/kg) being most common. Tramadol efficacy scores were highly variable in both elephants and rhinoceroses. While drug choices were similar among institutions, substantial variability in dosing regimens and reported efficacy between and within facilities indicates the need for pharmacokinetic studies and standardized methods of analyzing response to treatment to establish dosing regimens and clinical trials to establish efficacy and safety.

  17. Perioperative analgesia and the effects of dietary supplements.

    Science.gov (United States)

    Abe, Andrew; Kaye, Alan David; Gritsenko, Karina; Urman, Richard D; Kaye, Adam Marc

    2014-06-01

    With over 50,000 dietary supplements available, resurgence in consumer interest over the past few decades has resulted in an explosion of use of these agents worldwide. Disillusionment with current medications and belief in "natural medicines" has resulted in a multibillion dollar industry. Active ingredients in a number of herbs are being tested for therapeutic potential, and some are efficacious, so herbal medicines cannot be dismissed. The prevalence of herbology is further encouraged by a relatively relaxed policy of the FDA regarding these compounds, which they consider foods. As herbal products are included in the "supplement" category, there is no existing protocol for standardization of these products. There are numerous examples of herbals that can adversely affect patient recovery and outcomes in anesthesia. The prudent anesthesia provider will make sure to obtain correct information as to accurate herbal usage of each patient and attempt to discontinue these products two to three weeks prior to the delivery of an anesthetic. Postoperative analgesia, bleeding, and level of sedation can be negatively impacted related to herbal products and herbal-drug interactions. Over 90 herbal products are associated with bleeding and this can be a specific problem intraoperatively or when considering placement of a regional anesthetic for postoperative pain management.

  18. Fetal and maternal analgesia/anesthesia for fetal procedures.

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    Van de Velde, Marc; De Buck, Frederik

    2012-01-01

    For many prenatally diagnosed conditions, treatment is possible before birth. These fetal procedures can range from minimal invasive punctions to full open fetal surgery. Providing anesthesia for these procedures is a challenge, where care has to be taken for both mother and fetus. There are specific physiologic changes that occur with pregnancy that have an impact on the anesthetic management of the mother. When providing maternal anesthesia, there is also an impact on the fetus, with concerns for potential negative side effects of the anesthetic regimen used. The question whether the fetus is capable of feeling pain is difficult to answer, but there are indications that nociceptive stimuli have a physiologic reaction. This nociceptive stimulation of the fetus also has the potential for longer-term effects, so there is a need for fetal analgesic treatment. The extent to which a fetus is influenced by the maternal anesthesia depends on the type of anesthesia, with different needs for extra fetal anesthesia or analgesia. When providing fetal anesthesia, the potential negative consequences have to be balanced against the intended benefits of blocking the physiologic fetal responses to nociceptive stimulation.

  19. 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.

  20. Anesthesia and analgesia for caesaren section in dog

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    Vasiljević Maja

    2014-01-01

    Full Text Available This work presents a case of a pregnant female dog, of English bulldog breed, three years old, which was brought to Belgrade Faculty of Veterinary Medicine because of inability for normal parturition. Cesarean section is an urgent intervention both in human and in veterinary medicine. Anesthesia of a pregnant dog should be carried out very carefully, because of all the physiological changes that appear during pregnancy, as well as the impact of anesthetics on embryos themselves. Anesthetics, analgesics and sedatives pass through blood brain barrier, but also their transport goes through placenta to embryo, so for that reason it is not possible to anesthetize only mother and to avoid anesthesia effects on the embryo. Therefore, anesthetics with short time of action which metabolize quickly and have minimal negative effect on embryos are recommended. When choosing the right analgesics and anesthetics, there should be known that female dogs in which it is necessary to do Cesarean section belong to the group of high risk patients. Pregnant female dogs are exposed to hypoventilation, hypoxia, hypercapnia, intense heart work, vomiting and regurgitation as well. Reversible anesthetics are recommended to provide shorter duration time of anesthesia, and in accordance, inhalation anesthetics doses are minimal. Application of α2- agonist in premedication, propophol in induction, as well as maintaining general inhalation anesthesia with sevofluran, along with local analgesia, proved to be the ideal combination in this case of cesarean section.

  1. A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CLINIC AL TRIAL TO ASSESS THE EFFICACY OF DEXAMETHASONE TO PR OVIDE POSTOPERATIVE ANALGESIA AFTER PARAVERTEBRAL BLOCK I N PATIENTS UNDERGOING ELECTIVE THORACOTOMY

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    Dhurjoti Proad

    2013-01-01

    Full Text Available ABSTRACT:BACKGROUND: In an attempt to improve the recovery and early reha bilitation after thoracotomy, various methods of pain-relief ha ve been tried to prolong the duration and to improve the quality of postoperative analgesia. Parave rtebral block using steroids like dexamethasone, administered as an adjuvant along wi th local anaesthetic agents, could be of particular interest. METHODS: Fifty patients undergoing elective thoracotomy were randomly assigned to one of the following groups containing t wenty five patients each. Group D patients received 8 mg (2 ml of dexamethasone added to 18 m l of 0.25% levobupivacaine as paravertebral block (total volume 20 ml. Group L pat ients received 18 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (20 ml i n total as paravertebral block. Analgesic effect was evaluated by measuring pain intensity (VA S score and duration of analgesia. RESULTS: A longer delay was observed between paravertevral b lock with study medication and first requirement of supplementary analgesic in g roup D (602.24±78.72 minutes compared to group L (410.48±56.64 minutes. Total con sumption of diclofenac sodium in first 24 hours in postoperative period was significantly les s in group D. No significant side effects were noted. CONCLUSION: Dexamethasone, used as adjuncts to levobupivacaine f or thoracic paravertebral block in patients undergoing thoracotom y, improve the quality and prolong the duration of post operative analgesia.

  2. Anestesia para tratamento intraparto extra-útero em feto com diagnóstico pré-natal de higroma na região cervical: relato de caso Anestesia para tratamiento intraparto extraútero en feto con diagnóstico prenatal de higroma en la región cervical: relato de caso Anesthesia for ex utero intrapartum treatment of fetus with prenatal diagnosis of cervical hygroma: case report

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    Angélica de Fátima de Assunção Braga

    2006-06-01

    ós-operatória. CONCLUSÕES: As principais recomendações para a realização do EXIT são segurança materno-fetal, relaxamento uterino para manutenção do seu volume, da circulação útero-placentária e imobilidade fetal para facilitar o manuseio das vias aéreas.JUSTIFICATIVA Y OBJETIVOS: El tratamiento intraparto extraútero (EXIT constituye un procedimiento realizado durante la cesária, con preservación de la circulación feto-placentaria, que permite el manejo seguro de la vía aérea del feto, con riesgo de obstrucción de las vías aéreas. El objetivo de este relato fue el de presentar un caso de anestesia para EXIT, en feto con higroma cístico en la región cervical. RELATO DEL CASO: Paciente con 22 años, 37 semanas de gestación, sin antecedentes anestésicos, estado físico ASA I, sometida a EXIT para manejo de vía aérea e intubación traqueal en feto con riesgo para obstrucción de vías aéreas. El procedimiento se realizó bajo anestesia general asociada a peridural continua. En el preoperatorio fueron utilizados metoclopramida (10 mg y ranitidina (50 mg, por vía venosa. En el espacio peridural se administró bupivacaína a 0,25% con adrenalina (30 mg asociada a fentanil (100 µg, seguida de la introducción de catéter cefálico, para analgesia postoperatoria. El útero fue desplazado para la izquierda. La inducción anestésica se hizo en secuencia rápida, con fentanil, propofol y rocuronio y el mantenimiento con isoflurano en 2,5% a 3%, en O2 y N2O (50%. Después de la histerotomía, se procedió a la liberación parcial del feto, asegurando la circulación útero placentaria, siguiendo las maniobras de laringoscopia e intubación traqueal fetal. A continuación se realizó la liberación total del feto, con pinzamiento del cordón umbilical, administración de ocitocina (20 UI en infusión venosa continua seguida de metil-ergonovina (0,2 mg por vía venosa. Durante el procedimiento, la presión arterial sistólica materna se mantuvo por encima de 100 mm

  3. Toxicidad cutánea a corto plazo de pacientes con cáncer de mama tratados con radioterapia hipofraccionada

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    Rolando Loría-Ruiz

    2013-12-01

    Full Text Available Antecedentes: reportar la factibilidad y resultados de toxicidad cutánea en una cohorte de pacientes portadores de cáncer de mama, tratados con un esquema de hipofraccionamiento de radioterapia externa, con un manejo multidisciplinario. Métodos: utilizando un software SPSS v18, se realizó un análisis retrospectivo de 299 pacientes (6 H y 293 M, tratados entre marzo de 2009 y diciembre de 2011, en el Instituto Oncológico del Sureste, Murcia, España. La mediana de edad fue de 54 años (rango, 31-89; 145 (48,49% pacientes con cáncer de mama derecha y 154 (51,50% de mama izquierda. Con base en la 7ª ed AJCC, la etapificación patológica fue: 118 (39,5% pacientes T1, 114 (38,1% T2, 43 (14,1% T3, 11 (3,8% T4, 5 (1,7% Tis, 4 (1,3% Tx; 137 pacientes (45,8% eran N0, 94 (31,5% N1, 45 (15% N2, 20 (6,70% N3 y 3 (1,00% Nx. Todos los pacientes se sometieron a RTE con técnica 3D conformada con esquema hipofraccionado de 2,67 Gy/día, en 15 fracciones para una dosis total de 40.05 Gy. Se realizó irradiación electiva a la región supraclavicular en 169 pacientes, con igual fraccionamiento. El 100% de la muestra se sometió a cirugía, el 84,3% recibió quimioterapia (66,21% postoperatoria y 18,1% neoadyuvante. Resultados: sesenta y siete pacientes (23,1% presentaron toxicidad cutánea grado 2 al finalizar el tratamiento. No se reportó toxicidad cutánea aguda severa. Conclusión: el esquema de hipofraccionamiento empleado en cáncer de mama es factible y no ha demostrado incremento en la toxicidad aguda severa a nivel de piel.

  4. 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

  5. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Leonhardt, Jane Schwartz; Revald, Peter

    2011-01-01

    Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged...

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Advances in patient-controlled analgesia: the role of fentanyl ITS

    Directory of Open Access Journals (Sweden)

    Ian Power

    2009-01-01

    Full Text Available Ian Power, Jon G McCormackDepartment of Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Royal Infirmary, Edinburgh, UKAbstract: Effective pain relief is an essential component of a patient’s peri-operative care package. Good analgesia has been shown to reduce the incidence of cardiovascular, respiratory and thrombo-embolic complications following surgery. Satisfactory analgesia facilitates early patient ambulation following surgery, which may reduce in-patient stay. Patient-controlled analgesia (PCA systems are a well established standard therapy for acute post-operative pain; however some practical limitations limit their clinical utility. The fentanyl inotophoretic transdermal system (ITS is a novel self-contained needle-free PCA device, which delivers boluses of fentanyl transdermally. This system has been shown to provide analgesia equivalent to conventional PCA modalities, with unique design features that may confer advantages to patients and staff, including facilitating patient mobilization in the post-operative phase. This review will discuss the technology of iontophoretic systems, the pharmacology of transdermal fentanyl delivery, and some practical implications of the fentanyl ITS.Keywords: iontophoresis, transdermal, patient-controlled analgesia, fentanyl, post-operative pain

  8. 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.

  9. Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

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    Piedrahíta-Gutiérrez, Dany Leandro

    2016-07-01

    Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

  10. Arteterapia con personas con discapacidad intelectual

    OpenAIRE

    Lorenzo Pipkau, Milena

    2015-01-01

    Este proyecto pretende hacer una aproximaci??n al mundo del Arte Terapia y los beneficios que esta disciplina puede aportar a las personas con discapacidad intelectual. La idea surge de la experiencia previa de la autora en este ??mbito y con este colectivo. A trav??s de la documentaci??n bibliogr??fica se busca ampliar el conocimiento en cuanto al concepto de arteterapia y sus antecedentes, con la finalidad de elaborar una propuesta pr??ctica que se basar?? en el dise??o de un taller de arte...

  11. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

    1996-01-01

    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp...

  12. 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

  13. 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.

  14. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

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    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  15. Intrathecal administration of resiniferatoxin produces analgesia against prostatodynia in rats

    Institute of Scientific and Technical Information of China (English)

    TANG Wei; SONG Bo; ZHOU Zan-song; LU Gen-sheng

    2007-01-01

    Background Prostatodynia remains a difficult clinical problem. Resiniferatoxin (RTX), an ultrapotent vanilloid, can produce a selective and long-lasting desensitization of nociception via C-fiber sensory neurons. Substance P (SP) and calcitonin gene-related peptide (CGRP) released from C-fibers are key neurotransmitters in visceral pain. In this study,we evaluated the analgesic effect of intrathecal RTX on rat prostatodynia.Methods Male Sprague-Dawley rats were divided into 3 groups for different treatment. In group A, sham operation was preformed. In group B, 100 μl complete Freund's adjuvant (CFA) was injected into the rat's bilateral ventral prostate to induce chronic inflammation. In group C, after prostatitis formed, 50 μl 10 nmol/L RTX was injected into the rat's lumbosacral (L5-S2) vertebral canal. SP and CGRP contents in the spinal cord were investigated by immunohistochemistry and radioimmunoassay (RIA). Their transcriptional levels in dorsal root ganglion (DRG) were determined by reverse transcriptase polymerase chain reaction (RT-PCR). In addition, pelvic nerve afferent discharge was recorded to explore the neuro-electrophysiological mechanisms underlying RTX-induced effect.Results SP and CGRP released in the spinal cord and their synthesis in DRG were increased significantly in response to CFA-induced chronic prostatitis, whereas this increase was effectively inhibited by intrathecal RTX. Meanwhile, pelvic nerve afferent electrical activity was enhanced significantly in rats with chronic prostatitis, but it was attenuated markedly in RTX-treated rats paralleled by the change of neuropeptides.Conclusions Intrathecal RTX administration could produce an analgesic effect on rat prostatodynia. Suppression of pelvic nerve afferent electrical activity may be a crucial mechanism underlying RTX-induced analgesia. RTX intrathecal application may present a novel analgesic strategy of prostatodynia.

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Sedation and analgesia in the pediatric intensive care unit.

    Science.gov (United States)

    Tobias, Joseph D

    2005-08-01

    Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. Although the synthetic opioid fentanyl frequently is chosen for use in the PICU setting because of its hemodynamic stability, preliminary data suggest morphine may have a slower development of tolerance and may cause fewer withdrawal symptoms than fentanyl. Morphine's safety profile includes long-term follow-up studies that have demonstrated no adverse central nervous system developmental effects from its use in neonates and infants. In the critically ill infant at risk following surgery for congenital heart disease, clinical experience supports the use of the synthetic opioids, given their ability to modulate PVR and prevent pulmonary hypertensive crisis. Alternatives to the benzodiazepines and opioids include ketamine, pentobarbital, or dexmedetomidine. Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.

  19. [Use of analgesia and sedation in dental implantology in patients with concomitant hypertension].

    Science.gov (United States)

    Sitkin, S I; Davydova, O B; Kostin, I O; Gasparian, A L

    2015-01-01

    Dental implants surgery in patients with hypertension increases the risk of vascular complications. The aim of the study was to examine the effect of analgesia and sedation on blood pressure and postoperative pain in dental implantology. In 76 patients with hypertension implant surgery was performed under local anesthesia only (40 patients) or under local anesthesia with propofol sedation and pre-emptive analgesia with ketorolac (36 patients). Intraoperative systolic blood pressure in the second group was 20% less than in the first group while the intensity of pain in the postoperative period in the second group was three times less than in the first one. Propofol sedation in dental implantology provides hemodynamic stability in patients with concomitant hypertension and preemptive analgesia with ketorolac allows minimizing postoperative pain.

  20. Pulsed Nd: YAG laser induces pulpal analgesia: a randomized clinical trial.

    Science.gov (United States)

    Chan, A; Armati, P; Moorthy, A P

    2012-07-01

    This double-blind, randomized, clinical trial investigated the effectiveness and underlying mechanism of neural inhibition of pulsed Nd:YAG laser induction of pulpal analgesia compared with 5% EMLA anesthetic cream. Forty-four paired premolars from 44 orthodontic patients requiring bilateral premolar extraction from either dental arch were randomly assigned to the 'Laser plus Sham-EMLA' or 'EMLA plus Sham-Laser' treatment group. Analgesia was tested by an Electric Pulp Tester (EPT) and the cutting of a standardized cavity, which was terminated when participants reported sensitivity, and Visual Analogue Scale (VAS) and numbness were recorded. Statistical analyses were done by paired t test, McNemar's test, and a chi-squared test (p analgesia, by suppression of intradental nerve responses to electrical and mechanical stimuli. Such a laser provides an alternative for dental pain management (ANZ-Clinical Trial Registry: N12611001099910).

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    clinical trials even when combined with multimodal systemic analgesia. In contrast, LIA may have limited additional analgesic efficacy in THA when combined with a multimodal analgesic regimen. Postoperative administration of local anaesthetic in wound catheters did not provide additional analgesia when......In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...... the analgesic efficacy of LIA for early postoperative pain treatment. In addition, the analgesic efficacy of wound catheters and implications for length of hospital stay (LOS) were evaluated. Twenty-seven randomized controlled trials in 756 patients operated on with THA and 888 patients operated on with TKA...

  4. Molecular and cellular mechanisms of the age-dependency of opioid analgesia and tolerance

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    Zhao Jing

    2012-05-01

    Full Text Available Abstract The age-dependency of opioid analgesia and tolerance has been noticed in both clinical observation and laboratory studies. Evidence shows that many molecular and cellular events that play essential roles in opioid analgesia and tolerance are actually age-dependent. For example, the expression and functions of endogenous opioid peptides, multiple types of opioid receptors, G protein subunits that couple to opioid receptors, and regulators of G protein signaling (RGS proteins change with development and age. Other signaling systems that are critical to opioid tolerance development, such as N-methyl-D-aspartic acid (NMDA receptors, also undergo age-related changes. It is plausible that the age-dependent expression and functions of molecules within and related to the opioid signaling pathways, as well as age-dependent cellular activity such as agonist-induced opioid receptor internalization and desensitization, eventually lead to significant age-dependent changes in opioid analgesia and tolerance development.

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

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    Valdecy Ferreira de Oliveira Pinheiro

    2015-12-01

    Full Text Available 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.

  6. 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;

    , 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......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...... 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...

  7. Abscesso do músculo psoas em paciente submetida à analgesia por via peridural: relato de caso Absceso del músculo psoas en paciente sometida a analgesia por vía peridural: relato del caso Psoas muscle abscess after epidural analgesia: case report

    Directory of Open Access Journals (Sweden)

    Durval Campos Kraychete

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O abscesso do músculo psoas é uma complicação rara da analgesia peridural. O manuseio adequado dessa intercorrência é fundamental para uma boa resolução do quadro clínico. O objetivo deste relato foi discutir o diagnóstico e o tratamento do abscesso do músculo psoas. RELATO DO CASO: Paciente do sexo feminino, 65 anos, com dor neuropática nos membros inferiores de difícil controle com medicamentos por via sistêmica. Optou-se pela administração de opióide e anestésico local por via peridural como alternativa analgésica. Vinte dias após o uso contínuo da via peridural, a paciente começou a apresentar dor na região lombar, cefaléia e febre. A tomografia computadorizada da pelve revelou abscesso do músculo psoas, sendo indicada drenagem fechada e antibioticoterapia. CONCLUSÕES: A supervisão minuciosa do paciente é necessária e deve ser contínua quando um cateter peridural for colocado. Essa vigilância deve ser mantida após a sua retirada.JUSTIFICATIVA Y OBJETIVOS: El absceso del músculo psoas es una complicación rara de la analgesia peridural. El manoseo adecuado de esa situación intercurrente es fundamental para una buena resolución del cuadro clínico. El objetivo de este relato fue discutir el diagnóstico y el tratamiento del absceso del músculo psoas. RELATO DEL CASO: Paciente del sexo femenino, 65 años, con dolor neuropático en los miembros inferiores de difícil control con medicamentos por vía sistémica. Se optó por la administración de opioide y anestésico local por vía peridural como alternativa analgésica. Veinte días después del uso continuo de la vía peridural, la paciente empezó a presentar dolor en la región lumbar, cefalea y fiebre. La tomografía computadorizada de la pelvis reveló absceso del músculo psoas, siendo indicado el drenado cerrado y antibioticoterapia. CONCLUSIONES: La supervisión minuciosa del paciente es necesaria y debe ser continua cuando

  8. PROSPECTIVE RANDOMISED CONTROL STUDY OF POST OP EPIDURAL ANALGESIA WITH BUPIVACAINE AND FENTANYL VS. BUPIVACAINE AND CLONIDINE

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    Rachana

    2014-07-01

    Full Text Available The aim of the study was to compare the relative potencies and clinical characteristics of epidural Clonidine and Fentanyl with Bupivacaine in lower limb and lower abdominal surgeries using patient-controlled analgesia. In a randomised double-blinded study, 60 ASA I or II patients requiring epidural analgesia for post- operative pain relief were allocated to receive either 0.125% Bupivacaine with Clonidine 1µg/kg or 0.125% Bupivacaine with Fentanyl 1µg/kg via a sterile syringe by trained anaesthesiologists. Analgesia was established with 10-15 ml bolus of study solution. There were significant differences in onset time, duration and quality of analgesia, local anaesthetic consumption, between the two groups. We conclude that 0.125% Bupivacaine with Clonidine 1µg/kg group of patients clinically had better quality of analgesia and for a longer duration in comparison with patients receiving 0.125% Bupivacaine with Fentanyl 1µg/kg.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Estudo comparativo de midazolam com cetamina S(+ versus midazolam com bloqueio paracervical uterino para aspiração manual intra-uterina Estudio comparativo de midazolam con cetamina S(+ versus midazolam con bloqueo paracervical uterino para aspiración manual intrauterina Comparative study of midazolam with ketamine S(+ versus midazolam with uterine paracervical block for manual intrauterine aspiration

    Directory of Open Access Journals (Sweden)

    Vonaldo Torres de Almeida

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Avaliar a efetividade, a analgesia pós-operatória e o grau de satisfação e recomendação das pacientes submetidas à aspiração manual intra-uterina por meio da comparação de duas técnicas anestésicas. MÉTODO: Foram estudadas, prospectivamente, 80 pacientes distribuídas aleatoriamente em dois grupos. Todas receberam midazolam, por via venosa. Em seguida, o Grupo MC recebeu cetamina S(+ por via venosa e o Grupo MP, bloqueio paracervical uterino. Na sala de cirurgia a eficácia da técnica foi avaliada por três observadores (o pesquisador, o obstetra e o residente de obstetrícia e, após uma hora, foi avaliada por um observador que desconhecia a técnica realizada, a analgesia pós-operatória, os graus de satisfação de recomendação da paciente mediante escala verbal. RESULTADOS: As técnicas mostraram-se eficientes em 95% das pacientes do Grupo MC e 76,7% das pacientes do Grupo MP (p = 0,04. Entre as pacientes do Grupo MC, 67% não apresentaram dor após uma hora, enquanto no grupo MP a porcentagem de pacientes sem dor foi de 33,3% (p JUSTIFICATIVA Y OBJETIVOS: Evaluar la efectividad, la analgesia postoperatoria y el grado de satisfacción y recomendación de las pacientes sometidas a la aspiración manual intrauterina a través de la comparación de las técnicas anestésicas. MÉTODO: Formando parte de un estudio de prospección, se estudiaron 80 pacientes distribuidas aleatoriamente en 2 grupos. Todas recibieron midazolam por vía venosa. En seguida, el Grupo MC, recibió cetamina S(+ por vía venosa y el Grupo MP bloqueo paracervical uterino. En la sala de cirugía la eficacia de la técnica fue evaluada por tres observadores (el investigador, el obstetra y el residente de obstetricia y después de una hora, fue evaluada por un observador que desconocía la técnica realizada, la analgesia postoperatoria y los grados de satisfacción de recomendación de la paciente mediante escala verbal

  11. [The dispute and prospect of sedation and analgesia treatments in outpatient dental procedures].

    Science.gov (United States)

    Cong, Yu

    2015-12-01

    The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.

  12. Sterile water injection labour analgesia in a parturient with preeclampsia with thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Shivali Panwar

    2017-01-01

    Full Text Available Pregnancy induced hypertension is one of the most common causes of maternal morbidity and mortality. A G2L1A1 female with period of gestation 36 weeks presented in our hospital with early labour pains. She was a known case of pregnancy induced hypertension with thrombocytopenia and had been operated on the lumbar spine for Potts spine. She was administered intradermal sterile water injection labour analgesia every 3 hours. The labour was uneventful and patient had a normal vaginal delivery of a male baby. The postnatal course was uneventful and patient was satisfied with the labour analgesia.

  13. Age-dependency of analgesia elicited by intraoral sucrose in acute and persistent pain models.

    Science.gov (United States)

    Anseloni, Vanessa C Z; Weng, H-R; Terayama, R; Letizia, David; Davis, Barry J; Ren, Ke; Dubner, Ronald; Ennis, Matthew

    2002-05-01

    Treatment of pain in newborns is associated with problematic drug side effects. Previous studies demonstrate that an intraoral infusion of sucrose and other sweet components of mother's milk are effective in alleviating pain in infant rats and humans. These findings are of considerable significance, as sweet tastants are used in pain and stress management in a number of clinical procedures performed in human infants. The ability of sweet stimuli to induce analgesia is absent in adult rats, suggesting that this is a developmentally transient phenomenon. However, the age range over which intraoral sucrose is capable of producing analgesia is not known. We investigated the effects of intraoral sucrose (7.5%) on nocifensive withdrawal responses to thermal and mechanical stimuli in naive and inflamed rats at postnatal days (P) P0-21. In some rats, Complete Freund's adjuvant (CFA) was injected in a fore- or hindpaw to produce inflammation. In non-inflamed animals, for noxious thermal stimuli, sucrose-induced analgesia emerged at P3, peaked at P7-10, then progressively declined and was absent at P17. For mechanical forepaw stimuli, sucrose-induced analgesia emerged, and was maximal at approximately P10, then declined and was absent at P17. By contrast, maximal sucrose-induced analgesia for mechanical hindpaw stimuli was delayed (P13) compared to that for the forepaw, although it was also absent at P17. In inflamed animals, sucrose reduced hyperesthesia and hyperalgesia assessed with mechanical stimuli. Sucrose-induced analgesia in inflamed animals was initially present at P3 for the forepaw and P13 for the hindpaw, and was absent by P17 for both limbs. Intraoral sucrose produced significantly greater effects on responses in fore- and hindpaws in inflamed rats than in naive rats indicating that it reduces hyperalgesia and allodynia beyond its effects on responses in naive animals. These findings support the hypothesis that sucrose has a selective influence on analgesic

  14. Analgesia preemptiva em cirurgias de implantes dentários : estudo comparativo com dexametasona e cetorolaco

    OpenAIRE

    2014-01-01

    A analgesia preemptiva é um regime analgésico instituído previamente ao estímulo nocivo, com o objetivo de prevenir a hiperalgesia inflamatória e o subsequente estímulo que amplifica a dor no sistema nervoso central. Para aplicá-la na clínica cirúrgica odontológica, alguns fármacos com propriedades analgésicas e anti-inflamatórias têm sido avaliados, todavia com resultados ainda conflitantes. Por este motivo, propôs-se investigar, de forma comparativa, a analgesia preemptiva com dexametasona ...

  15. [Effect of met- and leu-enkephalins and their synthetic analog on stimulation and acupunture analgesia].

    Science.gov (United States)

    Ignatov, Iu D; Vasil'ev, Iu N; Kovalenko, V S; Titov, M I

    1981-08-01

    Experiments on unrestrained rats were carried out to study the effect of intraventricularly injected met- and leu-enkephalins and their synthetic analog Tyr-dAla-Cly-Phe-NH2 on analgesia induced by electrical stimulation of the central gray. It was shown that subanalgesic doses of enkephalins and their synthetic analog facilitated the appearance of analgesic action on subthreshold antinociceptive-brain stimulation and potentiated the analgesic effect of threshold central gray stimulation. Subanalgesic and low analgesic doses of the peptides increased antinociceptive effect of electroacupuncture. The data obtained are discussed from the standpoint of the implication of the peptidergic mechanisms in the realization of acupuncture and stimulation analgesia.

  16. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Giane Nakamura

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group. Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination

  17. 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.

  18. Analgesia e sedação da associação da clonidina e ropivacaína a 0,75% por via peridural no pós-operatório de colecistectomia aberta Analgesia y sedación de la asociación de la clonidina y ropivacaína a 0,75% por vía peridural en el pos-operatorio de colecistectomia abierta Analgesia and sedation with epidural clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A clonidina, quando administrada por via peridural, possui propriedades analgésicas e potencializa os efeitos dos anestésicos locais, ocorrendo, contudo, efeitos colaterais que incluem hipotensão arterial, bradicardia e sedação. O objetivo desse trabalho foi avaliar a analgesia e a sedação da clonidina associada à ropivacaína a 0,75% no pós-operatório de colecistectomia aberta. MÉTODO: Participaram da pesquisa 30 pacientes, de ambos os sexos, com idades variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA I e II, submetidos à colecistectomia, os quais foram distribuídos em dois grupos: Controle (GC, em que foi administrada ropivacaína a 0,75% (20 ml, associada ao cloreto de sódio a 0,9% (1 ml; Experimento (GE, em que foi injetada ropivacaína a 0,75% (20 ml, associada à clonidina (1 ml = 150 µg. A analgesia e a sedação foram observadas 2, 6 e 24 horas após o término do ato operatório. RESULTADOS: A média de idade no GC foi de 41 anos e de 37 anos no GE. A média de peso foi de 67 kg no GC e de 64 kg no GE. A sedação no pós-operatório foi significativamente maior nos pacientes as 2 e 6 horas do grupo experimento. A analgesia foi observada em maior número de pacientes do grupo experimento, quando comparada ao grupo controle. CONCLUSÕES: A associação de clonidina e ropivacaína produziu analgesia mais duradoura e sedação em pacientes, nos horários de observação de 2 e 6 horas.JUSTIFICATIVA Y OBJETIVOS: La clonidina, cuando administrada por vía peridural, posee propiedades analgésicas y potencializa los efectos de los anestésicos locales, ocurriendo por ello, efectos colaterales que incluyen hipotensión, bradicardia y sedación. El objetivo de ese trabajo fue evaluar la analgesia y la sedación de la clonidina asociada a la ropivacaína a 0,75% en el pos-operatorio de colecistectomia abierta. MÉTODO: Participaron de la pesquisa 30 pacientes, de ambos sexos, con

  19. Experiencia clínica con el colgajo músculo-cutáneo vertical de trapecio en reconstrucción de cabeza y cuello

    Directory of Open Access Journals (Sweden)

    S. Gallego-Gónima

    2014-03-01

    Full Text Available Presentamos nuestra experiencia clínica con la utilización del colgajo músculo-cutáneo vertical de trapecio para la reconstrucción de defectos en cabeza y cuello a través de la presentación de 10 pacientes con defectos de cobertura en estas áreas tratados entre junio del 2006 y octubre del 2013. Hacemos énfasis en las técnicas quirúrgicas utilizadas, los resultados obtenidos, las complicaciones y la evolución postoperatoria. El colgajo músculo-cutáneo vertical de trapecio es una opción versátil con características anatómicas confiables y que puede realizarse de forma segura para la reconstrucción de defectos de cobertura complejos de cabeza y cuello como primera elección o como alternativa cuando otros procedimientos han fallado y en pacientes en los cuales no es posible realizar una cirugía mayor.

  20. 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 ra...

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

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne;

    2005-01-01

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

  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...

  3. 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.

  4. 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

    there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded...

  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. PKC-mediated potentiation of morphine analgesia by St. John's Wort in rodents and humans.

    Science.gov (United States)

    Galeotti, Nicoletta; Farzad, Mersedeh; Bianchi, Enrica; Ghelardini, Carla

    2014-01-01

    Our purpose was to combine the use of morphine with clinically available inhibitors of protein kinase C (PKC), finally potentiating morphine analgesia in humans. Thermal tests were performed in rodents and humans previously administered with acute or chronic morphine combined or not with increasing doses of the PKC-blocker St. John's Wort (SJW) or its main component hypericin. Phosphorylation of the γ subunit of PKC enzyme was assayed by western blotting in the periaqueductal grey matter (PAG) from rodents co-administered with morphine and hypericin and was prevented in rodent PAG by SJW or hypericin co-administration with morphine, inducing a potentiation of morphine analgesia in thermal pain. The score of pain assessment in healthy volunteers were decreased by 40% when morphine was co-administered with SJW at a dose largely below those used to obtain an antidepressant or analgesic effect in both rodents and humans. The SJW/hypericin potentiating effect lasted in time and preserved morphine analgesia in tolerant mice. Our findings indicate that, in clinical practice, SJW could reduce the dose of morphine obtaining the same analgesic effect. Therefore, SJW and one of its main components, hypericin, appear ideal to potentiate morphine-induced analgesia.

  7. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study

    Directory of Open Access Journals (Sweden)

    Hossam A. ELShamaa

    2014-04-01

    Conclusion: The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

  8. 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

  9. 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

  10. Central administration of neuropeptide FF and related peptides attenuate systemic morphine analgesia in mice.

    Science.gov (United States)

    Fang, Quan; Jiang, Tian-nan; Li, Ning; Han, Zheng-lan; Wang, Rui

    2011-04-01

    Neuropeptide FF (NPFF) belongs to an opioid-modulating peptide family. NPFF has been reported to play important roles in the control of pain and analgesia through interactions with the opioid system. However, very few studies examined the effect of supraspinal NPFF system on analgesia induced by opiates administered at the peripheral level. In the present study, intracerebroventricular (i.c.v.) injection of NPFF (1, 3 and 10 nmol) dose-dependently inhibited systemic morphine (0.12 mg, i.p.) analgesia in the mouse tail flick test. Similarly, i.c.v. administration of dNPA and NPVF, two agonists highly selective for NPFF(2) and NPFF(1) receptors, respectively, decreased analgesia induced by i.p. morphine in mice. Furthermore, these anti-opioid activities of NPFF and related peptides were blocked by pretreatment with the NPFF receptors selective antagonist RF9 (10 nmol, i.c.v.). These results demonstrate that activation of central NPFF(1) and NPFF(2) receptors has the similar anti-opioid actions on the antinociceptive effect of systemic morphine.

  11. 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.

  12. 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.

  13. [Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome].

    Science.gov (United States)

    Errando, C L; Sifre, C; López-Alarcón, D

    1998-12-01

    Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

  14. 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

  15. Postoperative analgesia for Enhanced recovery in Joint replacement: Audit of a new electronic prescribing order set.

    Science.gov (United States)

    Wright, Jonathan; Cullinger, Benjamin; Bacarese-Hamilton, Ian

    2015-01-01

    Enhanced recovery in joint replacement has been shown to reduce length of inpatient stay, reduce re-admission rates, and can improve early functional recovery. Postoperative analgesia is an important component of the group of interventions required to form a holistic enhanced recovery protocol. The introduction of electronic prescribing provides the opportunity to introduce some standardisation, where clinically appropriate, in the prescription of an evidence based postoperative analgesia protocol. Enhanced recovery following joint replacement has been used at this institution since 2011. An order set for the postoperative analgesia protocol was introduced to the in house electronic prescribing system in August 2014 (JAC Medicines Management; JAC Computer Services Ltd., Basildon, UK). An audit was performed to follow the effect of the new system on compliance with the postoperative analgesia guidelines. Improvements were seen following introduction of the electronic prescribing protocol in all criteria of the guideline with a demonstrated improvement in overall compliance from 0% to 35% in the first loop, with subsequent audit showing further improvement to 59% compliance. Use of an embedded order set within an electronic prescribing system has demonstrated improved compliance with an enhanced recovery protocol. This ensures that the correct evidence based protocol is available to guide the junior clinician at the point of care, when the medication is being prescribed.

  16. Effect of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on maternal lactation

    Institute of Scientific and Technical Information of China (English)

    Hu Feng; Bao-Xia Chen; Xi Ren; Hong-Xia Zhu

    2016-01-01

    Objective:To observe the effect of application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on the lactation and neonates.Methods:The puerpera who were underwent cesarean section with different analgesia methods were observed. The included puerpera were performed with the cesarean section under combined spinal epidural anesthesia. A total of 30 puerpera who were given ropivacaine in combined with sufentanil epidural analgesia after operation were served as the observation group, while 30 cases who were intermittently given intramuscular injection of pethidine after operation were served as the control group. The postpartum analgesic effects in the two groups were observed. The radioimmunoassay was used to detect the plasma PRL level. The postpartum colostrum time, 24 h lactation number, and NBNA scores in the two groups were compared.Results:The postoperative VAS score in the observation group was significantly lower than that in the control group (P<0.05), while the plasma PRL level was significantly higher than that in the control group (P<0.05). The postoperative colostrum time in the observation group was significantly earlier than that in the control group (P<0.05), while the lactation number was significantly greater than that in the control group (P<0.05).Conclusions:Application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section can effectively alleviate the postoperative pain, and improve the lactation, with no obvious adverse reactions on the neonates and reliable effects.

  17. 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...

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

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    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.

  19. 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

  20. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

  1. Tratamiento farmacológico del dolor en pacientes con cáncer

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    René Fernando Rodríguez

    2006-09-01

    Full Text Available La Organización Mundial de la Salud define el cuidado paliativo como el cuidado total y activo en aquellos pacientes que no responden a un tratamiento curativo. El control del dolor, otros síntomas y los problemas psicológicos, sociales y espirituales son de fundamental importancia. La meta del cuidado paliativo es brindar la mejor calidad de vida a los pacientes y a sus familias. En el cuidado paliativo es necesario el manejo multidisciplinario. Nuevas estrategias como rotación de opioides y sus diferentes vías de administración pueden ofrecer analgesia con pocos efectos adversos.

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

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    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

  3. 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

  4. The critical role of spinal 5-HT7 receptors in opioid and non-opioid type stress-induced analgesia.

    Science.gov (United States)

    Yesilyurt, Ozgur; Seyrek, Melik; Tasdemir, Serdar; Kahraman, Serdar; Deveci, Mehmet Salih; Karakus, Emre; Halici, Zekai; Dogrul, Ahmet

    2015-09-05

    The opioid and non-opioid types of stress-induced analgesia have been well defined. One of the non-opioid type involve the endocannabinoid system. We previously reported that the spinal serotonin 7 receptor (5-HT7) blockers inhibit both morphine and cannabinoid-induced analgesia, thus we hypothesized that descending serotonergic pathways-spinal 5-HT7 receptor loop might contribute to stress-induced analgesia. Stress-induced analgesia was induced with warm (32°C) or cold (20°C) water swim stress in male Balb-C mice. The effects of intrathecal injection of a selective 5-HT7 receptor antagonist, SB 269970, of the denervation of serotonergic neurons by intrathecal administration of 5,7-dihydroxytryptamine (5,7-DHT) and of lesions of the dorsolateral funiculus on opioid and non-opioid type stress-induced analgesia were evaluated with the tail-flick and hot plate tests. The expression of 5-HT7 receptors mRNA in the dorsal lumbar region of spinal cord were analyzed by RT-PCR following spinal serotonin depletion or dorsolateral funiculus lesion. The effects of the selective 5-HT7 receptor agonists LP 44 and AS 19 were tested on nociception. Intrathecal SB 269970 blocked both opioid and non-opioid type stress-induced analgesia. Dorsolateral funiculus lesion or denervation of the spinal serotonergic neurons resulted in a marked decrease in 5-HT7 receptor expression in the dorsal lumbar spinal cord, accompanied by inhibition of opioid and non-opioid type stress-induced analgesia. However, the systemic or intrathecal LP 44 and AS 19 alone did not produce analgesia in unstressed mice. These results indicate that descending serotonergic pathways and the spinal 5-HT7 receptor loop play a crucial role in mediating both opioid and non-opioid type stress-induced analgesia.

  5. Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

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    Rafael DeRossi

    2012-02-01

    Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

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

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    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.

  7. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

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    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  8. Estudo comparativo entre doses de morfina intratecal para analgesia após cesariana

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    Francisco Amaral Egydio de Carvalho

    2013-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Analgesia após cesarianas é importante, pois puérperas com dor têm dificuldade na movimentação, o que prejudica o aleitamento. Morfina intratecal proporciona analgesia adequada e duradoura após cesarianas. O objetivo deste estudo foi comparar a qualidade da analgesia proporcionada por duas doses de morfina intratecal e seus efeitos colaterais em pacientes submetidas à cesariana. MÉTODO: Participaram do estudo 123 gestantes, com idade gestacional superior a 38 semanas e plano de cesariana eletiva. As gestantes foram alocadas de maneira aleatória em dois grupos que receberam 50 ou 100 µg de morfina intratecal (Grupo 50/Grupo 100. Todas as pacientes foram anestesiadas com 12 mg de bupivacaína 0,5% hiperbárica via intratecal. As pacientes foram avaliadas entre a 9ª e a 11ª horas e entre a 22ª e a 24ª horas após o bloqueio, em relação à qualidade da analgesia, ao consumo de analgésico, aos efeitos colaterais e à principal causa de desconforto nas primeiras 24 horas após a cirurgia. RESULTADOS: Os grupos foram semelhantes em relação aos dados antropométricos e antecedente obstétrico. Não houve diferença estatística na intensidade dolorosa entre os grupos. Nos dois grupos a dor foi maior nas primeiras 12 horas após a anestesia (p < 0,001. O consumo de cloridrato de tramadol e o intervalo até a primeira dose foram semelhantes nos dois grupos. Prurido foi o efeito colateral mais frequente, com incidência estatisticamente maior no Grupo 100 (p = 0,026. CONCLUSÕES: Morfina intratecal em 50 µg tem a mesma qualidade de analgesia que 100 µg, com menor incidência de efeitos colaterais.

  9. 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.

  10. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

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    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

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

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    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.

  12. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

    Science.gov (United States)

    Şen, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

    Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

  13. Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

    Science.gov (United States)

    Stav, Anatoli; Reytman, Leonid; Sevi, Roger; Stav, Michael Yohay; Powell, Devorah; Dor, Yanai; Dudkiewicz, Mickey; Bayadse, Fuaz; Sternberg, Ahud; Soudry, Michael

    2017-01-01

    Background The PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days. Results A total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the “blocks” groups versus the control group. Morphine consumption was significantly higher in the control group. Conclusions Pain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120) PMID:28178436

  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

    Directory of Open Access Journals (Sweden)

    Miriam C B Gazi

    2005-10-01

    recibieron 1 mg (1 mL de morfina diluida en 9 mL de solución fisiológica a 0,9% y los del G2 (n = 21 25 mg (10 mL de bupivacaína a 0,25% sin vasoconstrictor, por vía intra-articular. La intensidad del dolor fue evaluada por la escala numérica y verbal en los tiempos 0, 30, 60 minutos y 7 días, en reposo y en movimiento. Fueron evaluados la necesidad de complementación analgésica con paracetamol (500 mg, la dosis total de analgésico utilizado, la duración de la analgesia y la calidad de la analgesia (por el paciente. RESULTADOS: De los 39 pacientes estudiados, 31 completaron el estudio. No hubo diferencia significativa de la intensidad del dolor en reposo y en movimiento entre los dos grupos en los tiempos estudiados. No hubo diferencia entre los dos grupos en el tiempo entre la administración de la solución y la necesidad de complementación analgésica. La dosis media del paracetamol utilizada en el primer día de la semana fue de 796 mg del G1 y de 950 mg en el G2; la complementación en la semana fue de 3578 mg G1 y 5333 mg en el G2. CONCLUSIONES: El efecto analgésico de 1 mg de morfina y de 25 mg de bupivacaína a 0,25% sin vasoconstrictor intra-articular fueron semejantes.BACKGROUND AND OBJECTIVES: Osteoarthritis is the most common joint disease among elderly people. This study aimed at comparing the analgesic effects of intra-articular bupivacaine and morphine in knee osteoarthritis patients. METHODS: Thirty-nine patients were included in this randomized double-blind study and divided in two groups: G1 (n = 18 patients were given intra-articular 1 mg (1 mL morphine diluted in 9 mL of 0.9% saline, while G2 (n = 21 received intra-articular 25 mg (10 mL of 0.25% plain bupivacaine. Pain intensity was evaluated by numerical and verbal scale at 0, 30, 60 minutes and 7 days at rest and in movement. Evaluated parameters were analgesic supplementation requirement with paracetamol (500 mg, total analgesic dose throughout the study, analgesia duration and quality

  15. Traqueostomía percutánea con asistencia fibrobroncoscópica: una década de experiencia en un hospital universitario

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    Carlos M. Romero

    2015-06-01

    Full Text Available RESUMEN Objetivo: Evaluar eficacia y seguridad de la traqueostomía percutánea, mediante dilatación única con asistencia fibrobroncoscópica, en pacientes críticos sometidos a ventilación mecánica. Métodos: Entre los años 2004 y 2014, se incluyeron prospectivamente 512 enfermos consecutivos con indicación de traqueostomía según los criterios clínicos de nuestro centro. Un tercio de los pacientes fueron de alto riesgo. Se registraron variables demográficas, puntaje APACHE II, y días de ventilación mecánica previo a traqueostomía percutánea. La eficacia del procedimiento fue evaluada mediante tasa de éxito en su ejecución y necesidad de conversión a técnica abierta. La seguridad fue evaluada por tasa de complicaciones operatorias y postoperatorias. Resultados: La edad media del grupo fue 64 ± 18 años (203 mujeres y 309 varones. El puntaje APACHE II fue 21 ± 3. Los pacientes permanecieron en promedio 11 ± 3 días en ventilación mecánica antes de la realización de la traqueostomía percutánea. Todos los procedimientos se completaron exitosamente, sin necesidad de convertir a técnica abierta. Dieciocho pacientes (3,5% presentaron complicaciones operatorias. Cinco pacientes experimentaron desaturación transitoria, cuatro presentaron hipotensión relacionada a la sedación, y nueve presentaron sangrado menor, pero ninguno requirió transfusión. No se registraron complicaciones graves, ni muertes asociadas al procedimiento. Once pacientes (2,1% presentaron complicaciones postoperatorias. Siete presentaron sangrado menor y transitorio del estoma de la traqueostomía percutánea, 2 sufrieron desplazamiento de la cánula de traqueostomía y 2 desarrollaron infección superficial del estoma. Conclusión: La traqueostomía percutánea mediante la técnica de dilatación única con asistencia fibrobroncoscópica, parece ser efectiva y segura en enfermos críticos sometidos a ventilación mecánica, cuando es realizada por

  16. Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia Efeitos maternos e fetais da analgesia de parto pelas técnicas peridural e duplo bloqueio

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    Giane Nakamura

    2009-01-01

    Full Text Available OBJECTIVE: Epidural (EA and combined spinal-epidural (CSE techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. METHODS: Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group. Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS developed by Amiel-Tison. RESULTS: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. CONCLUSION: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.OBJETIVO: A peridural (AP e a técnica de duplo bloqueio (DB são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125% (grupo AP e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB. Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo

  17. Educar con significado o con sentido

    Directory of Open Access Journals (Sweden)

    José Joaquín García García

    2017-01-01

    Full Text Available Hoy día, tres tendencias influyen directamente en la conformación de la escuela. En primer lugar, el afán de encontrar la esencia de todo encumbró a la razón e hizo de la racionalidad el único valor a defender en las aulas. En segundo lugar, el sistema capitalista hizo lo mismo con aquello que tiene valor de uso y valor de cambio, es decir, con la mercancía, validando solo lo que puede tener una utilidad económica conocida o posible. Esto convirtió a la educación en un proceso para certificar y ganar dinero, desdibujando así su intención de formar personas. Finalmente, la visión masculina y eurocéntrica con su locura por quererlo dominar todo, y de pensar que el hombre era el dueño del planeta e inclusive la vida y el destino de los otros hombres, mutiló culturas y eliminó a la naturaleza de los currículums en los centros educativos.

  18. Analgesia de parto em paciente portadora de deficiência de proteína S: relato de caso Analgesia de parto en paciente portadora de deficiencia de proteína S: relato de caso Labor analgesia in protein S deficient patient: case report

    Directory of Open Access Journals (Sweden)

    Renato Mestriner Stocche

    2004-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Na deficiência de proteína S, uma glicoproteína com atividade anticoagulante, o risco de eventos tromboembólicos está aumentado. O objetivo deste relato é abordar o manuseio anestésico em paciente obstétrica portadora desta deficiência. RELATO DO CASO: Paciente com deficiência de proteína S, com 25 semanas de gestação, apresentou os seguintes resultados de exames: INR = 0,9, TTPA = 32 s (controle 25,6, proteína S = 35% (normal = 70% a 130%. Nos dois últimos trimestres de gravidez, fez uso de até 12000 U de heparina, cada 8 horas. Com 38 semanas, foi internada em trabalho de parto. Decorridas 8 horas da interrupção da heparina, já com TTPA 25,8 s (controle 27,8 s, realizou-se anestesia peridural injetando-se 6 ml de bupivacaína a 0,2% e fentanil (20 µg, seguido de infusão contínua. O tempo de infusão foi de 5 horas com dose total de 40 mg de bupivacaína. Não houve intercorrências e, 1 hora após a retirada do cateter, foi reiniciada heparina, por via subcutânea, 10.000 UI, a cada 12 horas. A mãe e o recém-nascido evoluíram bem, recebendo alta no terceiro dia do pós-parto. CONCLUSÕES: Grávidas com deficiência de proteína S devem receber anticoagulantes com o objetivo de manter o TTPA 2 vezes o valor controle. A heparina, por não atravessar a barreira placentária, é o anticoagulante de eleição em obstetrícia. O bloqueio pode ser realizado respeitando um tempo mínimo entre 4 a 6 horas entre a última dose de heparina e a realização da punção lombar, desde que os exames apresentem parâmetros de normalidade. Entretanto, nestes casos, a analgesia peridural pode auxiliar na profilaxia de eventos tromboembólicos.JUSTIFICATIVA Y OBJETIVOS: En la deficiencia de proteína S, una glucoproteína con actividad anticoagulante, el riesgo de eventos tromboembólicos está aumentado. El objetivo de este relato es abordar el manoseo anestésico en paciente obstétrica portadora de esta

  19. Comparison of single dose transdermal patches of diclofenac and ketoprofen for postoperative analgesia in lower limb orthopaedic surgery

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    Reetu Verma

    2016-03-01

    Conclusions: Both ketoprofen and diclofenac transdermal patch are effective for postoperative analgesia but less number of patients required rescue analgesic in ketoprofen group. [Int J Res Med Sci 2016; 4(3.000: 718-721

  20. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

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    Hala Mostafa Gomaa

    2014-10-01

    Conclusion: Either intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

  1. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination

    Directory of Open Access Journals (Sweden)

    Kalpana S Vora

    2012-01-01

    Conclusion: Epidural administration of a combination of sufentanil and morphine offered the advantage of faster onset of action and longer duration of analgesia as compared to the two drugs administered alone.

  2. Endocannabinoids and pain: spinal and peripheral analgesia in inflammation and neuropathy.

    Science.gov (United States)

    Rice, A S C; Farquhar-Smith, W P; Nagy, I

    2002-01-01

    Analgesia is an important physiological function of the endocannabinoid system and one of significant clinical relevance. This review discusses the analgesic effects of endocannabinoids at spinal and peripheral levels, firstly by describing the physiological framework for analgesia and secondly by reviewing the evidence for analgesic effects of endocannabinoids obtained using animal models of clinical pain conditions. In the spinal cord, CB(1) receptors have been demonstrated in laminae of the dorsal horn intimately concerned with the processing of nociceptive information and the modulation thereof. Similarly, CB(1) receptors have been demonstrated on the cell bodies of primary afferent neurones; however, the exact phenotype of cells which express this receptor requires further elucidation. Local administration, peptide release and electrophysiological studies support the concept of spinally mediated endocannabinoid-induced analgesia. Whilst a proportion of the peripheral analgesic effect of endocannabinoids can be attributed to a neuronal mechanism acting through CB(1) receptors expressed by primary afferent neurones, the antiinflammatory actions of endocannabinoids, mediated through CB(2) receptors, also appears to contribute to local analgesic effects. Possible mechanisms of this CB(2)-mediated effect include the attenuation of NGF-induced mast cell degranulation and of neutrophil accumulation, both of which are processes known to contribute to the generation of inflammatory hyperalgesia. The analgesic effects of cannabinoids have been demonstrated in models of somatic and visceral inflammatory pain and of neuropathic pain, the latter being an important area of therapeutic need. Analgesia is one of the principal therapeutic targets of cannabinoids. This review will discuss the analgesic effects of endocannabinoids in relation to two areas of therapeutic need, persistent inflammation and neuropathic pain. The more general aspects of the role of cannabinoids

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

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    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

  4. No morphine sparing effect of ketamine added to morphine for patient-controlled intravenous analgesia after uterine artery embolization

    DEFF Research Database (Denmark)

    Jensen, Luana Leonora; Handberg, Gitte; Helbo-Hansen, H S

    2008-01-01

    group, n=26) by i.v. patient-controlled analgesia (IV-PCA). Pump settings were bolus dose 1 ml, lockout 10 min, no background infusion. In addition, all patients received diclofenac and acetaminophen for pain relief. Pain scores, morphine consumption and adverse events like nausea, vomiting, itching...... conditions of basal analgesia with acetaminophen and diclofenac, we failed to demonstrate any morphine-sparing effect of IV-PCA ketamine and morphine compared with IV-PCA morphine alone....

  5. Investigando con personas con dificultades de aprendizaje

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    Borja González Luna

    2013-12-01

    Full Text Available El artículo muestra los orígenes de lo que Walmsley (2008 denomina «investigación inclusiva». Para comprender qué se entiende por investigación inclusiva tenemos que remontarnos a los debates epistemológicos sobre las metodologías cuantitativas y cualitativas, acontecidos en la década de los 90, en torno a la revista Disability & Society. A partir de una síntesis de dichos debates, focalizados en el ámbito de la «discapacidad intelectual y del desarrollo», se exponen dos estrategias de colaboración con dicha población: a una aproximación etnográfica (de trabajo grupal, y b una aproximación biográfica (de trabajo individual. A continuación se esboza un posible diseño de trabajo de campo que intenta superar el paradigma cualitativo «clásico» con el objetivo de incluir a dicho colectivo más allá del rol de «sujetos de la investigación». Para finalizar se recoge el debate sobre la accesibilidad de los resultados de la investigación a los participantes en dichas investigaciones, y con ello la necesaria innovación en el ámbito de las «devoluciones» de los resultados, cuando se trata de incluir a personas que presentan limitaciones para la comprensión del lenguaje abstracto oral y/o escrito.

  6. 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.

  7. The effects of Agaricus sylvaticus fungi dietary supplementation on the metabolism and blood pressure of patients with colorectal cancer during post surgical phase Efectos de la suplementación dietética con hongos Agaricus sylvaticus en el metabolismo y la presión arterial en pacientes con cáncer colorrectal en la fase postoperatoria

    OpenAIRE

    R. Costa Fortes; M.ª R. Carvalho Garbi Novaes

    2011-01-01

    Introduction: Metabolic, biochemical and enzymatic alterations are common in patients with cancer. Medicinal fungi has been used as adjuvants in cancer therapy due to its immunomodulatory and nutritional effects. Objective: The objective of this study was to evaluate the metabolic and blood pressure effects on patients with colorectal cancer after dietary supplementation with Agaricus sylvaticus. Methods: The methodology used was a randomized, double-blind, placebo-controlled clinical trial c...

  8. Research progress on labor analgesia%分娩镇痛研究进展

    Institute of Scientific and Technical Information of China (English)

    王丽敏; 燕美琴

    2014-01-01

    综述无痛分娩的研究进展,包括分娩疼痛对母婴的影响、无痛分娩方式的选择、分娩镇痛应用现状、常用的无痛分娩方法、分娩镇痛对剖宫产率的影响、分娩镇痛的护理。%It reviewed the research progress on painless childbirth,inclu-ding impact of painless childbirth on mother and infants,selection of painless delivery methods,application status quo of labor analgesia,com-mon painless delivery method,the influence of labor analgesiaon the ce-sarean section rate and the labor analgesia care.

  9. 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.

  10. Analgesia induced by morphine microinjected into the nucleus raphe magnus: effects on tonic pain.

    Science.gov (United States)

    Dualé, Christian; Sierralta, Fernando; Dallel, Radhouane

    2007-07-01

    One of the possible sites of action of the analgesic effect of morphine is the Nucleus Raphe Magnus, as morphine injected into this structure induces analgesia in transient pain models. In order to test if morphine in the Nucleus Raphe Magnus is also analgesic in a tonic pain model, 5 microg of morphine or saline (control) were microinjected into the Nucleus Raphe Magnus of the rat. Analgesic effects were assessed following nociceptive stimulation using transient heating of the tail (phasic pain) and subcutaneous orofacial injection of 1.5 % formalin (tonic pain). While morphine was strongly analgesic for the tail-flick response (p Magnus is not the exclusive site of action of morphine-induced analgesia in clinical conditions.

  11. 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

    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....../daily. No patient had a nasogastric tube, and oral feeding with normal food and protein enriched solutions (1000 Kcal (4180 KJ/day) was instituted 24 hours postoperatively together with intensive mobilisation. RESULTS: Median visual analogue pain scores were zero at rest and minimal during coughing and mobilisation...... weight loss. CONCLUSION: These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations....

  12. Morphine Analgesia Modification in Normotensive and Hypertensive Female Rats after Repeated Fluoxetine Administration.

    Science.gov (United States)

    Kosiorek-Witek, Anna; Makulska-Nowak, Helena Elżbieta

    2016-01-01

    The purpose of this investigation was to determine through the use of fluoxetine the effect of administering a serotonin reuptake inhibitor over several days on the antinociceptive action of μ-morphine type opioid receptor agonist. Investigations were performed on rats of both sexes, both the WKY normotensive strains as well as on the SHR genetically conditioned hypertensive strains. Results showed that the efficacy of morphine analgesia is higher in the SHR strain compared to normotensive rats (WKY). Surprisingly, repeated administration of fluoxetine reduced morphine analgesia, with the weakening of opioid antinociceptive action comparable to the duration of serotonin reuptake inhibitor administration. It was also concluded that the antinociceptive action of morphine in female rats and the alteration of its efficacy as a result of fluoxetine premedication for several days depend on oestrus cycle phase. The highest sensitivity of female rats to morphine was reported in the dioestrus and oestrus phases; much lower values were reported for the metoestrus phase.

  13. Mycobacterial toxin induces analgesia in buruli ulcer by targeting the angiotensin pathways.

    Science.gov (United States)

    Marion, Estelle; Song, Ok-Ryul; Christophe, Thierry; Babonneau, Jérémie; Fenistein, Denis; Eyer, Joël; Letournel, Frank; Henrion, Daniel; Clere, Nicolas; Paille, Vincent; Guérineau, Nathalie C; Saint André, Jean-Paul; Gersbach, Philipp; Altmann, Karl-Heinz; Stinear, Timothy Paul; Comoglio, Yannick; Sandoz, Guillaume; Preisser, Laurence; Delneste, Yves; Yeramian, Edouard; Marsollier, Laurent; Brodin, Priscille

    2014-06-19

    Mycobacterium ulcerans, the etiological agent of Buruli ulcer, causes extensive skin lesions, which despite their severity are not accompanied by pain. It was previously thought that this remarkable analgesia is ensured by direct nerve cell destruction. We demonstrate here that M. ulcerans-induced hypoesthesia is instead achieved through a specific neurological pathway triggered by the secreted mycobacterial polyketide mycolactone. We decipher this pathway at the molecular level, showing that mycolactone elicits signaling through type 2 angiotensin II receptors (AT2Rs), leading to potassium-dependent hyperpolarization of neurons. We further validate the physiological relevance of this mechanism with in vivo studies of pain sensitivity in mice infected with M. ulcerans, following the disruption of the identified pathway. Our findings shed new light on molecular mechanisms evolved by natural systems for the induction of very effective analgesia, opening up the prospect of new families of analgesics derived from such systems.

  14. [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.

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

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    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.

  16. A clinical study of the effectiveness of continuous epidural labour analgesia for vaginal delivery with 0.0625% bupivacaine with 0.0002% fentanyl

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    Vijay Kanna

    2015-10-01

    Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes. A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 and micro;g of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate. [Int J Res Med Sci 2015; 3(10.000: 2553-2560

  17. 多模式镇痛在脊柱外科微创手术中的应用①%Application of Multimodal Analgesia in Minimally Invasive Surgery for Patients in Spine Surgery

    Institute of Scientific and Technical Information of China (English)

    杨同文; 王强; 王增春; 白金柱; 洪毅; 张军卫

    2013-01-01

    Objective To apply the multimodal analgesia (MMA) in minimally invasive surgery (MIS) for patients in spine surgery. Methods 21 patients undergoing MIS were selected to be reviewed, including haemodynamics, respiratory parameters, analgesia and seda-tion scale, side effects, satisfaction of operators and patients in the course of the operation. Results All the MIS was successful with excel-lent analgesia, conscious sedation, stable haemodynamics, unsuppressed respiratory function, and satisfaction of operators and patients. Con-clusion Patients under MMA would accept MIS in a comfortable state and the communication between patients and operators would not be inhibited.%  目的探讨多模式镇痛在脊柱外科微创手术中的应用。方法选择21例在多模式镇痛模式下接受脊柱外科微创手术的患者,观察术中血流动力学、呼吸监测指标、镇痛镇静评分、不良反应事件、术者及患者对手术过程满意度评价。结果手术过程顺利,血流动力学稳定,呼吸功能无抑制,患者及术者对手术过程满意。结论多模式镇痛能够使患者在最舒适的环境下接受脊柱外科微创手术,同时不影响术者与患者在术中进行交流。

  18. 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.

  19. [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.

  20. Effects of ethylenediamine on morphine analgesia and tolerance-dependence in mice.

    Science.gov (United States)

    Contreras, E; Tamayo, L

    1985-01-01

    Ethylenediamine, a GABA receptor agonist induced a small hyperalgesic state in mice, but increased morphine analgesia. The interaction with this morphine effect was not dose-dependent. Ethylenediamine significantly antagonized tolerance development at relatively low doses (5-10 mg/kg). The GABA mimetic agent increased the frequency of abstinence signs in the naloxone-precipitated morphine withdrawal in mice. The effect of ethylenediamine on morphine withdrawal was suppressed by the irreversible GABA transaminase inhibitor, gamma-vinyl GABA.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Sedación consiente y analgesia en los niños

    OpenAIRE

    Duque Quintero, Jaime Raúl; Profesor Asociado, Profesor Catedrático, Universidad de Manizales

    2006-01-01

    Last decades have brought new diagnostic methods and treatment (TAC, magnetic resonance, etc) that require, especially in children, sedation or analgesia. Even though, sedation is now practiced more securely, thanks to the training and the existence of new drugs, monitoring units and postoperatory care; there are risks that should be avoided at the time of its practice.The points to look for at the sedation time are: the sedation’s nature (minimum, moderate, deep or general), age, patient’s p...

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Analgesia Evaluation of 2 NSAID Drugs as Adjuvant in Management of Chronic Temporomandibular Disorders

    OpenAIRE

    2015-01-01

    The aim of this triple-blind full-randomized clinical trial was to quantify analgesia in masticatory muscles and temporomandibular joints after occlusal splint therapy associated with the adjuvant administration of nonsteroidal anti-inflammatory drugs (NSAID) isolated or associated with other therapeutic agents. Pain relief was also recorded. Eighteen volunteers who had been suffering from chronic pain in masticatory muscles due to temporomandibular disorders were selected after anamnesis and...

  8. The effect of low-dose intravenous ketamine on continuous intercostal analgesia following thoracotomy

    Directory of Open Access Journals (Sweden)

    Alexandre Yazigi

    2012-01-01

    Full Text Available Ketamine, a noncompetitive N-methyl-d-aspartate antagonist, provides analgesia and prevents chronic pain following thoracotomy. The study was aimed to assess the effect of intravenous low-dose ketamine on continuous intercostal nerve block analgesia following thoracotomy. The study was a prospective, randomized, double-blinded, and placebo-controlled clinical study, performed in a single university hospital. Sixty patients, undergoing elective lobectomy through an open posterolateral thoracotomy, were included. For postoperative pain, all patients received a continuous intercostal nerve block with bupivacaine plus intravenous paracetamol and ketoprofen. In addition, patients were randomized to have intravenous ketamine (0.1 mg/kg as a preincisional bolus followed by a continuous infusion of 0.05 mg/kg/h in group 1 or intravenous placebo in group 2. Patients reporting a visual analog scale pain score at rest ≥40 mm received intravenous morphine sulfate as rescue analgesia. The following parameters were assessed every 6 hours for 3 postoperative days: Visual analog scale pain scores at rest and during coughing, requirement of rescue analgesia with morphine, Ramsay sedation scores and psychomimetic adverse effects. Both the groups were statistically comparable regarding visual analog scale pain scores at rest (P=0.75 and during coughing (P=0.70, number of morphine deliveries (P=0.17, cumulative dose of rescue morphine (P=0.2, sedation scores (P=0.4, and psychomimetic adverse effects (P=0.09. Intravenous low-dose ketamine, when combined with continuous intercostal nerve block, did not decrease acute pain scores and supplemental morphine consumption following thoracotomy.

  9. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

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    Udita Naithani

    2008-01-01

    Full Text Available Post traumatic stress resulting from an intensive care unit(ICU stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 months. Patient′s sedation level was assessed by Ramsay Sedation Scale (RSS = 1 : Agitated; 2,3 : Comfortable; 4,5,6 : Sedated and pain intensity by Behavioural Pain Scale (BPS = 3 :No pain, to 16 : Maximum pain. BPS, mean arterial pressure(MAP and heart rate(HR were assessed before and after painful stimulus (tracheal suction. Although no patient had received sedative and analgesics, mean Ramsay score was 3.52±1.92 with 30% patients categorized as ′agitated′, 12% as ′comfortable′ and 58% as ′sedated′ because of depressed consciousness level. Mean BPS at rest was 4.30±1.28 revealing background pain that further increased to 6.18±1.88 after painful stimulus. There was significant rise in HR (10.30%, MAP (7.56% and BPS (40.86% after painful stimulus, P< 0.0001. The correlation between BPS and Ramsay Score was negative and significant (P< 0.01. We conclude that there should be regular definition of the appropriate level of sedation and analgesia as well as monitoring of the desired level, using sedation and pain scales as a part of the total care for mechanically ventilated patients.

  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. 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....

  12. 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.

  13. 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.

  14. 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

  15. 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

  16. 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.

  17. 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.

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

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    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.

  19. 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.

  20. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

    Science.gov (United States)

    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  1. Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

    Directory of Open Access Journals (Sweden)

    Thaís Cristina Tebaldi

    2008-12-01

    ,5% (grupo CLON/HIPER; n = 11 o 2,5 mg de bupivacaína isobárica 0,5% (grupo CLON/ISO; n = 11 en asociación con el sufentanil 2,5 µg y la clonidina 30 µg. El dolor evaluado por la Escala Analógica Visual, la frecuencia cardíaca y la presión arterial promedio, fueron estudiados a cada 5 minutos en los primeros 15 minutos y a continuación, a cada 15 minutos hasta el nacimiento. Fue evaluada la prevalencia de efectos colaterales (náusea, vómito, prurito y sedación. El estudio fue terminado en el momento en que se hizo necesaria la complementación analgésica epidural (dolor > 3 cm o al nacimiento. El análisis estadístico fue realizado a través de los tests t de Student, Chi-cuadrado, Fisher y ANOVA de dos vías para medidas repetidas, considerando como significativo p BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (α-agonist prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesia¹. The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5% hyperbaric bupivacaine (CLON/HYPER Group; n = 11 or 2.5 mg of 0.5% isobaric bupivacaine (CLON/ISO Group; n = 11 associated with 2.5 µg of sufentanil and 30 µg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3 or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for

  2. 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

  3. 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.

  4. Soledad con espectador

    OpenAIRE

    2011-01-01

    Este proyecto se plantea como una investigación de las posibilidades del dibujo como una herramienta para relatar una historia propia que se empapa de realidad y de ficción con el deseo de confundir al espectador y suscitarle preguntas. Para ello me he servido de mi propia imagen como personaje central. Éste se presenta duplicado, multiplicado, repetido e interactúa consigo mismo en un espacio imaginario con intención de simular aquello que se revela en el interior de la psique. Mi trabajo se...

  5. Giochiamo con i robot

    Directory of Open Access Journals (Sweden)

    Andrea Bonarini

    2009-01-01

    Full Text Available "Giochiamo con i robot" e' un laboratorio interattivo per grandi e piccini realizzato per l'edizione 2007 del Festival della Scienza di Genova. Lungo un percorso che va dalla telerobotica alla robotica evolutiva, il laboratorio sviluppa il tema di dare intelligenza ai robot. Questo percorso, le cui tappe sono le varie installazioni, si conclude nella "bottega" dove e' possibile costruire e programmare i propri robot o smontare e modificare quelli esposti durante il percorso didattico. I visitatori sono coinvolti in attivita' ludiche grazie alle quali possonoentrare in contatto con alcune delle idee potenti della robotica,

  6. en pacientes con obesidad

    Directory of Open Access Journals (Sweden)

    Alcia María Alvarado Sánchez

    2005-01-01

    Full Text Available El objetivo de este estudio fue evaluar la eficacia de una intervención psicológica en pacientes con obesidad. Se utilizó un diseño cuasiexperimental con un grupo de estudio y un grupo control. Después de la intervención, se encontró una diferencia significativa en la reducción de peso entre los grupos. Asimismo, hubo un incremento significativo en la autoestima del grupo estudiado.

  7. Funcionando con la computadora

    OpenAIRE

    Álvarez, Eduardo; Astiz, Mercedes; Medina, Perla; Montero, Y.; Oliver, María; Rocerau, M. Cristina; VALDEZ, Guillermo; Vecino, María; Vilanova, Silvia

    2004-01-01

    En este trabajo se presenta la descripción y resultados de la segunda etapa de una experiencia planteada con el objetivo de indagar la manera en que los alumnos determinan e interpretan funciones que explican situaciones problemáticas valiéndose de una nueva forma de trabajo en el aula: la utilización de la computadora como herramienta y un programa asistente matemático. La primera etapa consistió en el desarrollo de un taller optativo con alumnos de entre 14 y 15 años de edad del Colegio Dr....

  8. Analgesia epidural com clonidina ou romifidina em cães submetidos à cirurgia coxofemoral

    Directory of Open Access Journals (Sweden)

    Brondani J.T.

    2004-01-01

    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 horas

  9. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora" Analysis of rejection of epidural analgesia during labor in Andalusian women: "the silent sufferer"

    Directory of Open Access Journals (Sweden)

    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  10. Nicotine Increases Codeine Analgesia Through the Induction of Brain CYP2D and Central Activation of Codeine to Morphine.

    Science.gov (United States)

    McMillan, Douglas M; Tyndale, Rachel F

    2015-06-01

    CYP2D metabolically activates codeine to morphine, which is required for codeine analgesia. Permeability across the blood-brain barrier, and active efflux, suggests that initial morphine in the brain after codeine is due to brain CYP2D metabolism. Human CYP2D is higher in the brains, but not in the livers, of smokers and 7-day nicotine treatment induces rat brain, but not hepatic, CYP2D. The role of nicotine-induced rat brain CYP2D in the central metabolic activation of peripherally administered codeine and resulting analgesia was investigated. Rats received 7-day nicotine (1 mg/kg subcutaneously) and/or a single propranolol (CYP2D mechanism-based inhibitor; 20 μg intracerebroventricularly) pretreatment, and then were tested for analgesia and drug levels following codeine (20 mg/kg intraperitoneally) or morphine (3.5 mg/kg intraperitoneally), matched for peak analgesia. Nicotine increased codeine analgesia (1.59X AUC(0-30 min) vs vehicle; p0.1). Nicotine increased, while propranolol decreased, brain, but not plasma, morphine levels, and analgesia correlated with brain (p0.4), morphine levels after codeine. Pretreatments did not alter baseline or morphine analgesia. Here we show that brain CYP2D alters drug response despite the presence of substantial first-pass metabolism of codeine and further that nicotine induction of brain CYP2D increases codeine response in vivo. Thus variation in brain CYP2D activity, due to genetics or environment, may contribute to individual differences in response to centrally acting substrates. Exposure to nicotine may increase central drug metabolism, not detected peripherally, contributing to altered drug efficacy, onset time, and/or abuse liability.

  11. 蛛网膜下腔联合硬膜外腔阻滞用于分娩镇痛时机的探讨%Occasion of Administration of Combined Spinal Epidural Analgesia and Patient-control Epidural Analgesia on Labor—Latent Stage Analgesia versus Active Stage Analgesia

    Institute of Scientific and Technical Information of China (English)

    范建辉; 滕奔琦; 李萍; 李晓芸; 朱娟

    2011-01-01

    摘要:[目的]探讨实施蛛网膜下腔阻滞-硬膜外联合分娩镇痛时机对产程和分娩结局的影响.[方法]370例产妇按照宫颈口开张程度分为2组,潜伏期组130例在宫颈口开张l ~2 cm时开始实施蛛网膜下腔阻滞-硬膜外联合镇痛,活跃期组240例在宫颈口开张3~8cm时开始实施镇痛,记录2组产妇年龄、孕周、孕次、产程、分娩方式、缩宫素应用情况、产后24h出血量、胎儿窘迫、羊水粪染、新生儿体质量及新生儿生物物理评分(即1 min及5 min Apgar评分)、新生儿黄疸.[结果]潜伏期组和活跃期组比较,潜伏期延长[(453±203)min vs,(338±182)min,P=0.000].活跃期组的活跃期时间明显延长[(229±109) min vs (197±101)min,P=0.011].第2、3产程和总产程比较差异无统计学意义(P=0.200,P=0.222,P=0.091).潜伏期组的缩宫素使用率较高(43.08%vs 23.33%,P=0.012).两组器械助产率、剖宫产率、产后24h出血量比较差异无统计学意义(P>0.05).胎儿窘迫率、新生儿生物物理评分、新生儿高胆红素血症发生率2组比较差异无统计学意义(P>0.05).[结论]潜伏期实施联合分娩镇痛可能抑制子宫收缩、延长潜伏期,正确使用缩宫索可以减少分娩镇痛带来的不利影响.%[Objective]This study was designed to explore whether combined spinal-epidural analgesia (CSEA) and patient-control epidural analgesia (PCEA ) has influence on labor progress and adverse events between latent stage analgesia and active stage analgesia. [Methods] The subjects were divided into two groups; latent stage analgesia group ( 130 cases) received CSEA+PCEA in latent phase (cervical dilatation was 0.05). There were no significant differences in the rate of fetal distress or neonatal Apgar scorces and neonatal jaundice between the two groups (P > 0.05). [Conclusions] CSEA + PCEA in the latent phase was associated with an increased risk of inhibition of uterine contraction and prolonged

  12. Cobertura de tobillo con colgajo de hemisóleo de flujo retrógrado: más allá de su indicación clásica

    Directory of Open Access Journals (Sweden)

    J.R. Manzani-Baldi

    2013-09-01

    Full Text Available Planteamos 5 casos clínicos de fractura expuesta de tobillo con pérdida de cobertura cutánea y una revisión de la vascularización del músculo sóleo. Basándonos en conceptos anatomo-hemodinámicos, realizamos la cobertura de dichos defectos con un colgajo muscular de hemisóleo a pedículo distal y flujo retrógrado. El colgajo se llevó más allá de su indicación clásica a partir de la selección de pacientes según puntuación en base a patología previa y edad. En todos los casos la vitalidad del colgajo fue buena y los resultados anatomo-funcionales obtenidos fueron satisfactorios. La recuperación postoperatoria fue de un promedio de 3 semanas, más rápida que la esperada con otros métodos.

  13. fertilizada con diferentes abonos

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Elizondo-Salazar

    2007-01-01

    Full Text Available Producción y calidad de la biomasa de morera (Morus alba fertilizada con diferentes abonos. Se llevó a cabo un experimento en la Estación Experimental “Alfredo Volio Mata” de la Universidad de Costa Rica con el fi n de evaluar la aplicación de 150 kg de N/ha/año proveniente de dos abonos orgánicos: lombriabono y compostaje; y de un fertilizante químico, sobre la producción y calidad de la biomasa de morera. El periodo experimental comprendió un ciclo de 12 meses, iniciando en julio del 2003 y fi nalizando en julio del 2004. Se utilizó una plantación de morera de 12 años de establecida con una densidad de siembra de 27.777 plantas/ ha. Se empleó un diseño de bloques completos al azar con cuatro tratamientos: dos abonos orgánicos, nitrato de amonio (33,5% N y un control. Las plantas se podaron a 0,6 m sobre el nivel del suelo al inicio del ensayo. Durante el periodo experimental, las plantas fueron podadas consecutivamente cada 90 días. Las hojas y los tallos fueron separados y analizados para determinar el contenido de materia seca y proteína cruda. La producción de materia seca fue 23% superior y el contenido de proteína cruda fue signifi cativamente mayor con el nitrógeno químico, mientras que el contenido de materia seca fue menor. No se encontraron diferencias signifi cativas entre el tratamiento control y los tratamientos orgánicos.

  14. Ear tagging in piglets: the cortisol response with and without analgesia in comparison with castration and tail docking.

    Science.gov (United States)

    Numberger, J; Ritzmann, M; Übel, N; Eddicks, M; Reese, S; Zöls, S

    2016-11-01

    The objectives of the present study were to compare the cortisol response caused by ear tagging piglets with the distress caused by other known painful husbandry procedures (e.g. castration and tail docking) and to evaluate the effectiveness of analgesia with meloxicam to reduce the cortisol response caused by these procedures. In total, 210 male piglets were randomised to equal numbers (n=30) into one of seven groups: a control group which was only handled (H), an ear tagged group that received no analgesia (ET), an ear tagged group with analgesia (ETM), a castration group with no analgesia (C), a castration group with analgesia (CM), a tail-docked group with no analgesia (TD) and a tail-docked group with analgesia (TDM). The procedures were carried out on day 3 or 4 after farrowing. Five blood samples were taken from each piglet: 30 min before the respective procedure (baseline value), and 30, 60 min, 4 and 7 h after processing, to assess cortisol concentrations. Means as well as the area under the curve (AUC) value were analysed and the effective sizes of the procedures were established. At 7 h after the experimental treatment, cortisol concentrations had returned to base values in all groups. ET evoked a greater cortisol response than H piglets at 30 min (Pcortisol response to ET was lower than C at 30 min (P=0.001) but did not differ significantly at the other sample times. The mean cortisol response was similar between ET and TD piglets over all sample times. Taking both intensity and duration of the cortisol response into account (AUC), ET evoked a greater response than TD. Analgesia (ETM) resulted in significantly lower cortisol levels than ET at 30 and 60 min post-procedure. Castration (C) provoked the highest cortisol response of all procedures; a significant analgesic effect (CM) was shown only at 4 h post-procedure. TD resulted in significantly higher cortisol levels than H piglets only at 30 min; analgesia (TDM) significantly reduced the cortisol

  15. 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

  16. Atitudes de anestesiologistas e médicos em especialização em anestesiologia dos CET/SBA em relação aos bloqueios nervosos dos membros superior e inferior Actitudes de anestesiólogos y médicos en especialización en anestesiología de los CET/SBA con relación a los bloqueos nerviosos de los miembros superior e inferior The attitude of anesthesiologists and anesthesiology residents of the CET/SBA regarding upper and lower limb nerve blocks

    Directory of Open Access Journals (Sweden)

    Pablo Escovedo Helayel

    2009-06-01

    aumentado en la práctica anestesiológica, debido a una menor necesidad de instrumentación de las vías aéreas, a un menor coste y a una excelente analgesia postoperatoria. Sin embargo, su utilización sufre restricciones causadas por la falta de entrenamiento, un mayor tiempo de realización, el temor de las complicaciones neurológicas y la toxicidad sistémica. El objetivo de este estudio, fue medir las actitudes de anestesiólogos y médicos en especialización en los Centros de Enseñanza y Entrenamiento (CET/SBA con relación a los BNP. MÉTODO: Se constituyó un cuestionario con 25 ítems, quedando a disposición electrónicamente y por correo, para los responsables de 80 CET, sus instructores y médicos en especialización. RESULTADOS: Cuarenta y dos CET (52,5% devolvieron 188 cuestionarios, siendo 62 (32% médicos en especialización (ME y 126 (68% anestesiólogos. El coeficiente de confiabilidad de Cronbach del cuestionario fue de 0,79. El análisis factorial reveló seis factores que explicaron un 53% de la variancia de los puntajes: factor 1 - actitudes positivas, responsables de un 18,34 % de la variancia; factor 2 - entrenamiento/aplicación, responsable de un 11,73 % de la variancia; factor 3 - aspectos negativos, responsable de un 7,11 % de la variancia; factor 4 - factores limitantes, responsable de un 6,39 % de la variancia; factor 5 - anestesia regional como diferencial de competencia, responsable de un 5,79 % de la variancia; y factor 6 - respecto del paciente, responsable de un 5,4 % de la variancia. CONCLUSIONES: El cuestionario pareció ser una herramienta fidedigna para mensurar las actitudes con relación a la anestesia regional. Los anestesiólogos demostraron un mayor interés en los aspectos relacionados con los pacientes, mientras los ME tuvieron como foco principal la adquisición de habilidades técnicas.BACKGROUND AND OBJECTIVES: The use of regional blocks especially peripheral nerve blocks (PNB has been increasing in anesthesiology due to

  17. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction.

    Science.gov (United States)

    Yu, C; Li, S; Deng, F; Yao, Y; Qian, L

    2014-09-01

    Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). Recorded variables were patient preoperative anxiety scores, vital signs, visual analogue scale (VAS) pain scores, Observer's Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, surgeon and patient degree of satisfaction, and the duration of analgesia after surgery. The OAAS scores were significantly lower for patients administered D/F compared to those who received M/F. The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3 h) than in those who received M/F (4.1 h; P=0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P=0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.

  18. COMPARATIVE STUDY OF CAUDAL ROPIVACAINE AND ROPIVACAINE - CLONIDINE COMBINATION IN PAEDIATRIC UROGENITAL SURGERIES FOR POST - OPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Ravi

    2015-07-01

    Full Text Available BACKGROUND: Addition of clonidine to ropivacaine (0.2% can potentially enhance analgesia without producing prolonged motor blockade. The aim of the study was to compare the post - operative pain relieving quality of ropivacaine (0.2% and clonidine mixture to that of p lain ropivacaine (0.2% following caudal block in children’s. OBJECTIVE: In this study I examined the quality, post - operative analgesia and haemodynamics effects in children when clonidine is added to ropivacaine for urogenital surgeries in caudal anaesthe sia. MATERIAL AND METHODS: In this clinical trial, 30 children’s aged 1 - 10 years who were candidates for elective urogenital surgeries were studied. Induction and maintenance of anaesthesia were achieved using propofol, sevoflurane and nitrous oxide. Child ren were randomly divided into 2 groups in double blind fashion, and were given caudal block with 0.2% ropivacaine (1ml/kg alone and ropivacaine plus clonidine 2mcg/kg. Haemodynamic parameters were observed before, during and after the surgical procedure. Post - operative analgesia evaluated using FLACC score and sedation was assessed using Ramsey sedation scale. Paracetamol was given orally for cases with FLACC score 4 or more. RESULTS: Duration of analgesia was found to be significantly longer in the group given ropivacaine plus clonidine. CONCLUSIONS: I concluded that addition of clonidine to ropivacaine prolongs the duration of post - operative analgesia without any respiratory or heamodynamic side - effects.

  19. Analgesia peridural para o trabalho de parto e para o parto: efeitos da adição de um opióide Effects of the association of an opioid with epidural analgesia for labor and delivery

    Directory of Open Access Journals (Sweden)

    José Guilherme Cecatti

    1998-07-01

    Full Text Available O objetivo deste estudo foi avaliar a eficácia e segurança da associação bupivacaína com sufentanil para a analgesia no trabalho de parto e do parto por meio de um bloqueio peridural contínuo. Realizou-se um ensaio clínico duplo-cego, prospectivo e aleatório, incluindo sessenta mulheres nulíparas da Maternidade do CAISM/UNICAMP. No momento da analgesia, as mulheres foram aleatoriamente alocadas em dois grupos: BS, recebendo 12,5 mg de bupivacaína com adrenalina mais 30 µg de sufentanil e BP, recebendo 12,5 mg de bupivacaína com adrenalina mais placebo. Foram avaliados os parâmetros relativos à qualidade e duração da analgesia, duração do trabalho de parto e também possíveis efeitos sobre o recém-nascido. Os resultados mostraram a superioridade da adição do sufentanil sobre o grau de analgesia durante o tempo de ação da primeira dose de anestésico local. Não houve aumento na duração do trabalho de parto depois do início da analgesia quando se compararam ambos os grupos, nem qualquer diferença quanto à via de parto. Não houve também diferenças entre os grupos com relação à avaliação dos recém-nascidos. Conclui-se que a associação de 30 µg de sufentanil à primeira dose de bupivacaína é segura e eficaz, melhorando a qualidade da analgesia, sua duração e não afetando a progressão do trabalho de parto e o resultado neonatal.The purpose of the present study was to evaluate the efficacy and safety of the association bupivacaine with sufentanil for labor and delivery analgesia through a continuous epidural blockade, for both mother and the neonate. A randomized double blind prospective clinical trial was performed including sixty nulliparous women at the Maternity of CAISM/UNICAMP. When requesting analgesia, the women were randomly allocated to two groups: BS, receiving 12.5 mg of bupivacaine with adrenaline plus 30 µg of sufentanil and BP, receiving 12.5 mg of bupivacaine with adrenaline plus placebo

  20. Análisis de la no elección de la analgesia epidural durante el trabajo de parto en las mujeres andaluzas: "la buena sufridora"

    Directory of Open Access Journals (Sweden)

    L. Biedma Velázquez

    2010-02-01

    Full Text Available Introducción: La analgesia epidural se ha popularizado en España, tanto en su conocimiento como en su uso, a lo largo de los últimos 20 años. La elección de esta técnica analgésica por parte de la futura madre durante el trabajo de parto y el parto en Andalucía es un derecho de la mujer que, explícitamente, sólo estará limitado por sus condiciones físicas y de salud y por los recursos disponibles en el hospital en el momento del parto. Esta elección pone en relación 2 elementos: por un lado, el componente cognitivo que establece la conveniencia o no de utilizar esta técnica según los valores, percepciones, cultura, etc. de la mujer y, por otro, el componente conductual, es decir, el uso o no de la técnica en cuestión, que dependerá además de la elección de la mujer de las condiciones anteriormente mencionadas. Objetivo: Analizar qué características definen a las mujeres que, aun pudiendo, deciden no utilizar analgesia epidural durante el parto en Andalucía. Material y métodos: Para ello se ha utilizado la información proporcionada por las mujeres ingresadas por parto en los hospitales del Sistema Sanitario Público de Andalucía, contenida en las encuestas anuales de satisfacción de usuarios del sistema de atención hospitalario en esta comunidad autónoma entre los años 2000 y 2007. Con esta información se ha realizado un análisis de segmentación jerárquica que tenía por objetivo analizar el perfil de las mujeres que rechazan esta técnica analgésica. Resultados: Las principales características que definen a las mujeres que rechazan la analgesia epidural durante el parto vienen dadas por su nivel educativo, nivel de ingresos y situación laboral. Conclusiones: Las características sociales, económicas y culturales que definen el rechazo, es decir, el "tipo" de mujer que rehúsa la epidural, coinciden con el esquema de "mujer tradicional" estudiado por otros autores (que se caracteriza por tener escasos

  1. sistema Web con JSP

    Directory of Open Access Journals (Sweden)

    César Viloria Núñez

    2014-01-01

    Full Text Available Este artículo presenta el desarrollo de un sistema de información que permite la adquisición y la administración de información relacionada con los signos vitales como la presión arterial, la frecuencia cardiaca y respiratoria, y la saturación de oxígeno en la sangre de un paciente. La implementación del sistema se basa en una solución Web, permitiendo así que médicos especialistas puedan monitorear a sus pacientes desde cualquier punto conectado a la red en tiempo real y, al mismo tiempo, dar indicaciones críticas al personal médico que se encuentra en el lugar con el paciente.

  2. Transporte forestal con cables

    OpenAIRE

    Anaya L. Héctor J.

    2012-01-01

    La explotación forestal es un problema fundamentalmente de transporte. El apeo y la preparación de las trozas, aunque a veces presentan algunas dificultades, son operaciones fáciles de resolver comparadas con la operación de transporte la cual absorbe del 60% al 70% o más del costo total del aprovechamiento del bosque. El 30% o 40% restante es absorbido por las faenas previas de apeo y troceo.

  3. Encuentros con Elena Poniatowska

    OpenAIRE

    Uzquiza González, José Ignacio

    2008-01-01

    El autor analiza, desde su encuentro con Elena Poniatowska, la vertiente de la literatura testimonial como literatura de mujeres. Un análisis interior de la relación entre realidad y ficción, entre Elena, Jesusa o Tinísima. The author analyzes testimonial literature from the perspective of female literature through his meeting with Elena Poniatowska. An analysis of reality vs. Fiction in Elena, Jesusa and Tinisima.

  4. pacientes con falla cardiaca

    Directory of Open Access Journals (Sweden)

    Diana Marcela Achury Saldaña

    2007-01-01

    Full Text Available Objetivo: determinar la adherencia al tratamiento de pacientes con falla cardiaca hospitalizados, al aplicar un plan educativo quefomenta el autocuidado.Método: estudio cuasiexperimental (entrevistas enfermera-paciente realizado entre diciembre de 2004 y mayo de 2006, con unamuestra de 50 pacientes seleccionados por conveniencia. Se diseñó un instrumento para evaluar los comportamientos de los pacientes,con base en algunos resultados de la adherencia y sus respectivos indicadores de la taxonomía NOC (Nursing out comes classification. Laadherencia al tratamiento fue medida en dos momentos: el primero durante la hospitalización, seguido de la aplicación del plan educativoantes del alta, que proporcionaba información en el manejo de su enfermedad desde una dimensión física, psicológica y social quepromueve el autocuidado; y el segundo un mes después del alta en su domicilio.Resultados: diferencias estadísticamente significativas (P=0,0001 que demuestran cómo mediante la capacitación al paciente enel manejo de su tratamiento farmacológico y no farmacológico, el establecimiento de una sana relación entre el profesional de enfermeríay el paciente, y la participación de la familia, se logra una total adherencia al tratamiento.Conclusiones: para lograr una adherencia total del paciente con falla cardiaca al tratamiento es necesario un proceso educativo y unseguimiento continuo y personalizado que motive permanentemente al paciente y se le reconozca el papel protagónico en su cuidado y manejo de la enfermedad.

  5. 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....

  6. Lectura con adolescentes

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    Silvia Méndez Anchía

    2007-01-01

    Full Text Available Con base en la premisa de que la lectura de textos literarios tiene una función formadora y que esta se acentúa en la adolescencia, me propongo demostrar que el cuento “Rapunzel” puede utilizarse como estrategia para explorar algunas situaciones que los sujetos adolescentes perciben como particulares en relación con su vida, pero que se inscriben dentro de grandes problemáticas estudiadas por varias disciplinas. Para ello, he identificado, desde dos marcos de referencia (sociológico y psicoanalítico, diversas problemáticas y discursos que se desprenden de la lectura del cuento realizada por dos mujeres adolescentes, quienes respondieron una guía de lectura y participaron en una entrevista a profundidad. Concluyo que la lectura y comentario del cuento hacen posible que una serie de experiencias que los sujetos adolescentes viven como únicas (como el embarazo de una amiga, las críticas de las personas adultas y las exigencias de padres y madres, ingresen en el circuito de los conocimientos generales al relacionarlas con los discursos y problemáticas en que se inscriben (por ejemplo, el discurso de la “crisis” de la adolescencia, el enfoque de derechos humanos, el mundo fantasmático materno. Por ello, recomiendo la lectura y comentario de textos literarios como estrategia didáctica para contribuir a la elaboración de la subjetividad de personas adolescentes.

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

    OpenAIRE

    M. I. Segado-Jiménez; J. Arias-Delgado; F. Domínguez-Hervella; M. L. Casas-García; A. López-Pérez; C. Izquierdo-Gutiérrez

    2011-01-01

    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 duran...

  8. 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...

  9. 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.

  10. EFFECT OF INTRATHECAL ROPIVACAINE WITH DEXMEDETOMIDINE FOR OPERATIVE AND POST OPERATIVE ANALGESIA: A PROSPECTIVE RANDOMIZED STUDY

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    Nitish Kumar

    2014-03-01

    Full Text Available BACKGROUND: This prospective randomized double blind study was conducted to evaluate the effect and safety of intrathecal dexmedetomidine added to isobaric ropivacaine. MATERIALS AND METHODS: 120 adult female patients, who underwent vaginal hysterectomies, were randomly allocated to receive intrathecally either 3 ml of 0.75% isobaric ropivacaine + 0.5 ml normal saline (Group R or 3 ml of 0.75% isobaric ropivacaine +5 μg dexmedetomidine in 0.5 ml of normal saline (Group D. Following intrathecal administration, duration of onset of sensory and motor blockade, maximum dermatomal level achieved, duration of analgesia, hemodynamic parameters and incidence of side effects were observed. RESULTS: Duration of onset of sensory block upto T10, T8 and the highest level of block achieved i. e. T6 were similar in both the groups. The mean time of sensory regression to S2 was 297.71±34.11 min in group D and 221.35±22.70 min in group R. Time to achieve Bromage score 0 was significantly slower with the addition of dexmedetomidine (229.37±28.74 min in group R vs. 258.55±30.46 min in group D. Duration of postoperative analgesia was significantly greater in group D (270.00±38.75 min as compared to group R (174.77±22.31 min. The maximum VAS score for pain was less in group D (4.42±0.69 as compared to group R (7.03±0.78. There were no significant difference in hemodynamic parameters and incidence of side effects in both the groups. CONCLUSION: The addition of dexmedetomidine to ropivacaine intrathecally produces significantly longer sensory and motor blockade along with better postoperative analgesia, and excellent hemodynamic stability without any significant side effects.

  11. 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.

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

    Science.gov (United States)

    de Souza Hobaika, Adriano Bechara

    2014-07-01

    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.

  13. The Effect of Painless Labor Using Intrathecal Labor Analgesia on Newborn’s Performance

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    Nita Ratna Dewanti

    2016-04-01

    Full Text Available The oxygen saturation is similar while in ILA’s babies have slightly higher non ILA’s babies. Even though all of the results doesn’t have any significant p value. It conclude that Painless labor using intrathechal analgaesia (ILA is a safe choice for parturient women with low pain tolerance. Therefore, this will have no effect in neonatal outcomes. The aim of the study is to examine the safety of painless labor using intratechal labor analgesia in neonatal outcomes. A prospective cohort study of 69 neonates who were born in Bintaro Hospital and Archa Medika Hospital, Indonesia was performed from February to August 2015 Parturient women chose whether they preferred painless labor using ILA to normal delivery without analgesia (NDWA. Fentanly 25ug, bupivacaine 2,5mg, and clonidine 0,045ug were administered as ILA. The neonates were immediately assessed to determine whether they were vigorous or not, followed by Apgar score measurement at one and five minutes after birth, and the changes of oxygen saturation from birth to first ten minutes of life. Results of this study show that a total of 69 neonates were included in the study, of whom 34 babies was born from mother who is received ILA as painless labor, while 35 babies was born from mother without any analgesia. Maternal characteristics including age in addition to neonatal gender and vigorousity may vary but were homogenously distributed both in both groups (ILA and non-ILA groups. Only one baby required resuscitation in pervaginam delivery. Fisher’s exact test showed no differences between the two groups in vigorousity. Further, no significant differences in Apgar score at first and fifth minute after delivery between both groups. Apgar score in ILA’s babies was 10 in all neonates at 10th minute while the mean Apgar score of 9.94±0.34 in non ILA’s babies.

  14. Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine.

    Science.gov (United States)

    Alagol, A; Calpur, O U; Usar, P Saral; Turan, N; Pamukcu, Z

    2005-11-01

    We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

  15. 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

    2014-07-01

    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.

  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. Neostigmine does not prolong the duration of analgesia produced by caudal bupivacaine in children undergoing urethroplasty

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    Bhardwaj N

    2007-01-01

    Full Text Available Context : Neostigmine extends the duration of analgesia produced by caudal bupivacaine in children. Aims : To study the effect of different doses of caudal neostigmine on the duration of postoperative analgesia. Settings and Design : A randomized, double-blind study was conducted in 120 boys aged 1-12 years undergoing urethroplasty under combined general and caudal anesthesia. Materials and Methods : Children were administered 1.875 mg/kg bupivacaine alone (Group B, or with 2, 3 or 4 µg/kg of neostigmine (groups BN 2 , BN 3 or BN 4 respectively as caudal drug (0.75 ml/kg. Children with a pain score of 4 or more (OPS and NRS postoperatively were administered rescue analgesic. Time to first analgesic and the number of analgesic doses administered in the 24h were recorded. Statistical Analysis : Parametric data were analyzed using ANOVA. Kaplan-Meier survival curves for the time to first analgesic administration were plotted and compared using log rank analysis. Chi-square test was used to analyze the incidence data. Results : The median [IQR] time to first analgesic in Group B (540 [240-1441] min was similar to that in Groups BN 2 (450 [240-720], BN 3 (600 [360-1020] and BN 4 (990 [420-1441]. Significantly more patients in Groups B (9 [34.6%] and BN 4 (13 [44.8%] required no supplemental analgesic for 24h than those in Groups BN 2 and BN 3 (4 [13.8%] and 4 [13.3%]. The number of analgesic doses required in 24h in the four groups was similar. Conclusion : Addition of neostigmine to 1.875 mg/kg of caudal bupivacaine did not prolong the analgesia following urethroplasty in children.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Influence of repeated painful procedures and sucrose analgesia on the development of hyperalgesia in newborn infants.

    Science.gov (United States)

    Taddio, Anna; Shah, Vibhuti; Atenafu, Eshetu; Katz, Joel

    2009-07-01

    This study determined the effects of cumulative exposure to painful needle procedures and sucrose analgesia on the development of remote hyperalgesia in newborn infants, defined as an increase in response to a normally painful stimulus at a site distal from the site of injury. One-hundred and twenty healthy newborns and 120 healthy newborn infants of diabetic mothers equally randomized to sucrose analgesia or placebo prior to all needle procedures in the first two days after birth were divided into two exposure groups according to number of needle procedures they had undergone [high (> or =5) or low (pain response during a subsequent venipuncture distal to the site of previous injury, assessed by the Premature Infant Pain Profile (PIPP) [7.1 vs. 8.4; p=0.012] and Visual Analog Scale (VAS) [2.5 cm vs. 3.2 cm; p=0.047], and a trend for longer cry duration [25.7 s vs. 33.8 s; p=0.171]. PIPP scores did not differ during a routine diaper change, suggesting a nociceptive specific mechanism for the remote hyperalgesia to venipuncture. Sucrose reduced PIPP, VAS, and cry duration scores during venipuncture, but did not prevent hyperalgesia (p>0.05). There was a preponderance of infants of diabetic mothers in the high exposure group; however, the analysis did not demonstrate this to be a confounding factor. In conclusion, sucrose analgesia for repeated painful procedures in the first day of life does not prevent development of remote hyperalgesia in newborns.

  1. Mechanisms of nociceptive transduction and transmission: a machinery for pain sensation and tools for selective analgesia.

    Science.gov (United States)

    Binshtok, Alexander M

    2011-01-01

    Many surgical and dental procedures depend on use of local anesthetics to reversibly eliminate pain. By the blockade of voltage-gated sodium channels, local anesthetics prevent the transmission of nociceptive information. However, since all local anesthetics act non-selectively on all types of axons they also cause a loss of innocuous sensation, motor paralysis and autonomic block. Thus, approaches that produce only a selective blockade of pain fibers are of great potential clinical importance. In this chapter we will review the recent findings describing mechanisms of pain transduction and transmission and introduce novel therapeutic approaches to produce pain-selective analgesia.

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

    DEFF Research Database (Denmark)

    Carstensen, M.; Møller, Ann

    2010-01-01

    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......, MEDLINE (1966-2009), and EMBASE (1980-2009) and by hand-searching reference lists from review articles and trials. Eleven studies were identified with a total of 887 patients. Quality and validity assessment was performed on all trials included using the Oxford Quality Scale with an average quality score...

  3. Refinement of analgesia following thoracotomy and experimental myocardial infarction using the Mouse Grimace Scale

    Science.gov (United States)

    Faller, Kiterie M. E.; McAndrew, Debra J.; Schneider, Jurgen E.

    2015-01-01

    New Findings What is the central question of this study? There is an ethical imperative to optimize analgesia protocols for laboratory animals, but this is impeded by our inability to recognize pain reliably. We examined whether the Mouse Grimace Scale (MGS) provides benefits over a standard welfare scoring system for identifying a low level of pain in the frequently used murine surgical model of myocardial infarction. What is the main finding and its importance? Low‐level pain, responsive to analgesia, was detected by MGS but not standard methods. In this model, most of the pain is attributable to the thoracotomy, excepted in mice with very large infarcts. This approach represents a model for assessing postsurgical analgesia in rodents. The Mouse Grimace Scale (MGS) was developed for assessing pain severity, but the general applicability to complex postsurgical pain has not been established. We sought to determine whether the MGS provides benefits over and above a standard welfare scoring system for identifying pain in mice following experimental myocardial infarction. Female C57BL/6J mice (n = 60), anaesthetized with isoflurane, were subjected to thoracotomy with ligation of a coronary artery or sham procedure. A single s.c. dose of buprenorphine (1.1 mg kg−1) was given at the time of surgery and pain assessed at 24 h by MGS and a procedure‐specific welfare scoring system. In some animals, a second dose of 0.6 mg kg−1 buprenorphine was given and pain assessment repeated after 30 min. The MGS was scored from multiple photographs by two independent blinded observers with good correlation (r = 0.98). Using the average MGS score of both observers, we identified a subset of mice with low scores that were not considered to be in pain by the welfare scoring system or by single observer MGS. These mice showed a significant improvement with additional analgesia, suggesting that this low‐level pain is real. Pain attributable to the myocardial injury, as

  4. 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.

  5. 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