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- ItemAcesso aberto (Open Access)Efeito da nifedipina gel 0,2% nas pressões de canal anal e na dor pós-operatória: estudo após hemorroidectomia pela técnica aberta(Cidade Editora Científica Ltda, 2007-12-01) Cesar, Maria Auxiliadora Prolungatti; Klug, Wilmar Artur; Bassi, Deomir Germano [UNIFESP]; Paula, Pedro Roberto De [UNIFESP]; Cesar, Rosana Prolungatti; Ortiz, Jorge Alberto; Speranzini, Manilio Basilio; FCMSCSP; Universidade de Taubaté; Universidade Federal de São Paulo (UNIFESP); Hospital Universitário de Taubaté Serviço de Endoscopia e Motilidade Digestiva; Faculdade de Ciências Médicas da Santa Casa de São Paulo; Universidade de São Paulo (USP); Faculdade de Medicina do ABCINTRODUCTION: Hemorrhoids are very common and pain following their surgical treatment causes great suffering. Various alternatives have been studied for reducing postoperative pain. Among these is surgical sphincterotomy, which may in some cases cause some degree of fecal incontinence. For this reason, several studies have used chemical sphincterotomy, with nifedipine, diltiazem, glycerin trinitrate or botulinum toxin. The objective of the present study was to investigate the effects of topical nifedipine for reducing anal canal pressures and consequently reducing postoperative pain. MATERIAL AND METHOD: Topical gels of 0.2% nifedipine plus 2% lidocaine (Group 1) and 2% lidocaine alone (Group 2) were used following hemorrhoidectomy. Pressures were measured before the operation and on the first, fourth and seventh days after the operation. Pain was also evaluated on all of the first seven postoperative days using a visual analog scale. RESULTS: There were no differences in relation to anal canal pressures, but lower pain levels were reported in the group that received nifedipine. CONCLUSION: Nifedipine gel was efficient for postoperative analgesia, but did not alter anal canal pressures.
- ItemAcesso aberto (Open Access)Efetividade do tratamento da dor pós-operatória de pacientes submetidos a cirurgia abdominal de médio e grande porte em dois hospitais públicos de Brasília(Universidade Federal de São Paulo (UNIFESP), 2010-10-27) Gaudard, Ana Márcia Yunes Salles [UNIFESP]; Saconato, Humberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Moderate to intense pain is prevalent after surgical procedures and it is associated with increases in postoperative morbidity and mortality. Objective: Evaluate the effectiveness of control and the factors associated with perception of pain intensity in patients undergoing abdominal surgery in hospital surgical clinics of two public hospitals in Brasilia Methods: Transversal and descriptive study, through document analysis, and interviews with patients, performed at two public hospitals from Brasilia. Data were collected about clinical features, surgical procedures and pain management from 342 patients. Pain was evaluated using the visual analog scale on the first 48 postoperative hours. The results were compared with data encountered on the bibliographic review. Results: 100% of patients in the prescription of analgesics postoperative was not based on the best scientific evidence. Moderate to intense pain was observed in 38.9% of patients. The most prescribed analgesic drug was dipyrone (83.6%). Of the patients using dipyrone alone, 29.2% of patients reported moderate to intense pain. Moderate to intense pain was significantly associated with women, with the use of anesthetic procedures other than epidural and therapeutic plans prescribed by the attending doctor. The majority of patients (50.9%) didn’t receive previous information about postoperative pain, 61% of patients who were in pain didn’t ask for relief and 80% of them had records of pain assessment, but without the use of scales and pain characterization. Conclusions: Postoperative pain management in the evaluated hospitals does not follow conducts based on the best evidence. The postoperative pain was more severe in female patients and in patients under treatment regimens prescribed by staff
- ItemSomente MetadadadosEffect of intraoperative intravenous lidocaine on pain and plasma interleukin-6 in patients undergoing hysterectomy(Elsevier B.V., 2015-03-01) Oliveira, Caio Marcio Barros de [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Slullitel, Alexandre; Salomão, Reinaldo [UNIFESP]; Lanchote, Vera Lucia; Issy, Adriana Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Sao Domingos; Soc Anestesiol Estado Maranhao; Assoc Paulista Med; Universidade de São Paulo (USP)Background and objectives: Interleukin-6 (IL-6) is a predictor of trauma severity. the purpose of this study was to evaluate the effect of intravenous lidocaine on pain severity and plasma IL-6 after hysterectomy.Method: A prospective, randomized, comparative, double-blind study with 40 patients, aged 18-60 years. G1 received lidocaine (2 mg.kg(-1).h(-1)) or G2 received 0.9% saline solution during the operation. Anesthesia was induced with O-2/isoflurane. Pain severity (T0: awake and 6, 12, 18 and 24 hours), first analgesic request, and dose of morphine in 24 hours were evaluated. IL-6 was measured before starting surgery (TO), five hours after the start (T5), and 24 hours after the end of surgery (124).Results: There was no difference in pain severity between groups. There was a decrease in pain severity between TO and other measurement times in G1. Time to first supplementation was greater in G2 (76.0 104.4 min) than in G1 (26.7 23.3 min). There was no difference in supplemental dose of morphine between G1 (23.5 12.6 mg) and G2 (18.7 +/- 11.3 mg). There were increased concentrations of IL-6 in both groups from TO to T5 and T24. There was no difference in IL-6 dosage between groups. Lidocaine concentration was 856.5 +/- 364.1 ng.mL(-1) in T5 and 30.1 +/- 14.2 ng.mL(-1) in T24.Conclusion: Intravenous lidocaine (2 mg.kg(-1).h(-1)) did not reduce pain severity and plasma levels of IL-6 in patients undergoing abdominal hysterectomy. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
- ItemSomente MetadadadosTramadol wound infiltration is not different from intravenous tramadol in children: a randomized controlled trial(Elsevier Science Inc, 2016) Giraldes, Ana Laura Albertoni [UNIFESP]; Sousa, Angela Maria; Slullitel, Alexandre; Guimaraes, Gabriel Magalhaes Nunes; Santos, Melina Genevieve Mary Egan; Pinto, Renata Evangelista; Ashmawi, Hazem Adel; Sakata, Rioko Kimiko [UNIFESP]Study Objective: The purpose of this trial was to assess if tramadol wound infiltration is superior to intravenous (IV) tramadol after minor surgical procedures in children because tramadol seems to have local anesthetic like effect. Design: Randomized double-blind controlled trial. Setting: Postanesthesia care unit. Patients: Forty children, American Society of Anesthesiologists physical status I or II, scheduled to elective inguinal hernia repair. Interventions: Children were randomly distributed in 1 of 2 groups: IV tramadol (group 1) or subcutaneous infiltration with tramadol (group 2). At the end of the surgery, group 1 received 2 mg/kg tramadol (3 mL) by IV route and 3-mL saline into the surgical wound; group 2 received 2 mg/kg tramadol (3 mL) into the surgical wound and 3-mL saline by IV route. Measurements: In the postanesthesia care unit, patients were evaluated for pain intensity, nausea and vomiting, time to first rescue medication, and total rescue morphine and dipyrone consumption. Main Results: Pain scores measured during the postanesthesia recovery time were similar between groups. Time to first rescue medication was shorter, but not statistically significant in the IV group. The total dose of rescue morphine and dipyrone was also similar between groups. Conclusions: We concluded that tramadol was effective in reducing postoperative pain in children, and there was no difference in pain intensity, nausea and vomiting, or somnolence regarding IV route or wound infiltration. (C) 2016 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosTramadol wound infiltration is not different from intravenous tramadol in children: a randomized controlled trial(Elsevier Science Inc, 2016) Giraldes, Ana Laura Albertoni [UNIFESP]; Sousa, Angela Maria; Slullitel, Alexandre; Guimaraes, Gabriel Magalhaes Nunes; Santos, Melina Genevieve Mary Egan; Pinto, Renata Evangelista; Ashmawi, Hazem Adel; Sakata, Rioko Kimiko [UNIFESP]Study Objective: The purpose of this trial was to assess if tramadol wound infiltration is superior to intravenous (IV) tramadol after minor surgical procedures in children because tramadol seems to have local anesthetic like effect. Design: Randomized double-blind controlled trial. Setting: Postanesthesia care unit. Patients: Forty children, American Society of Anesthesiologists physical status I or II, scheduled to elective inguinal hernia repair. Interventions: Children were randomly distributed in 1 of 2 groups: IV tramadol (group 1) or subcutaneous infiltration with tramadol (group 2). At the end of the surgery, group 1 received 2 mg/kg tramadol (3 mL) by IV route and 3-mL saline into the surgical wound; group 2 received 2 mg/kg tramadol (3 mL) into the surgical wound and 3-mL saline by IV route. Measurements: In the postanesthesia care unit, patients were evaluated for pain intensity, nausea and vomiting, time to first rescue medication, and total rescue morphine and dipyrone consumption. Main Results: Pain scores measured during the postanesthesia recovery time were similar between groups. Time to first rescue medication was shorter, but not statistically significant in the IV group. The total dose of rescue morphine and dipyrone was also similar between groups. Conclusions: We concluded that tramadol was effective in reducing postoperative pain in children, and there was no difference in pain intensity, nausea and vomiting, or somnolence regarding IV route or wound infiltration. (C) 2016 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosTranscutaneous Electrical Nerve Stimulation for Pain Relief After Liposuction: A Randomized Controlled Trial(Springer, 2015-04-01) Silva, Milla Pompilio da [UNIFESP]; Liebano, Richard Eloin; Rodrigues, Victor Ales [UNIFESP]; Felipe Abla, Luiz Eduardo [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ City São Paulo UNICIDLiposuction is a common cosmetic surgical procedure, which requires analgesia for postoperative pain. Transcutaneous electrical nerve stimulation (TENS) has been used for postoperative pain relief; however, there is no evidence of its effectiveness in liposuction patients and this is the focus of this paper.A prospective, randomized, double-blind, controlled trial was conducted with 42 adult patients who underwent liposuction. Patients were randomly allocated to either the TENS group (active TENS) or control group (sham TENS). All patients received morphine (0.1 mg/kg) and dipyrone 1 g immediately after surgery; TENS was delivered 2 h later. the primary outcome was pain intensity. Secondary outcomes were analgesic requirement, number and types of adverse effects of TENS, quality of pain, treatment success, and patient satisfaction. Postoperative pain was measured using a visual analog scale (VAS) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ).Patients in the TENS group reported significantly lower pain intensity (P < 0.001, effect size = 0.92) compared with those in the control group. TENS significantly decreased the consumption of analgesics in the postoperative period (P < 0.001). No withdrawals or adverse effects were observed in the TENS group, but 33.3 % of patients in the control group reported drowsiness and nausea. About 95 and 38 % of patients in the TENS and control groups, respectively, were satisfied with the analgesic treatment.The results indicate that TENS is effective as an adjunct to analgesics for pain relief after liposuction.This journal requires that authors assign a level of evidence to each article. for a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
- ItemAcesso aberto (Open Access)Tratamento da dor após procedimento cirúrgico ambulatorial(Sociedade Brasileira para o Estudo da Dor, 2013-03-01) Pereira, Rodney Junqueira [UNIFESP]; Munechika, Masashi [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND AND OBJECTIVES: Adequate postoperative pain control is critical for any outpatient surgical procedure. This study aimed at evaluating analgesics and techniques used to manage pain of this type of procedure. CONTENTS: Factors associated to postoperative pain intensity, parameters to be considered for outpatient surgeries, major management techniques for pain relief and the uniqueness of some surgical procedures were addressed. CONCLUSION: Effective pain control is critical for outpatient surgeries and is aimed not only at comfort but also at decreasing complications and early rehabilitation of patients. Multimodal analgesia is beneficial, but management has to be tailored since there are several drugs and techniques for pain relief.