Academic literature on the topic 'Analgesia Balanceada'

As particularidades anatômicas inerentes a espécie equina predispõem a mesma a síndrome cólica, sendo, predominantemente, seu tratamento cirúrgico. Esta situação impõe alguns desafios, pois o paciente se apresenta hemodinamicamente instável e com alto grau de sensibilidade álgica, tendo normalmente a equipe cirúrgico-anestésica pouco tempo para estabilização e tomada de decisão cirúrgica. Anestésicos inalatórios, como isofluorano, são fármacos amplamente utilizados em anestesia equina, no entanto, podem agravar o quadro hemodinâmico do paciente de maneira dose-dependente, sendo de extrema importância a inserção de anestesia multimodal no protocolo farmacológico, o que deve minimizar efeitos colaterais, otimizando a anestesia e a analgesia no período peri-operatório. Dentre os fármacos utilizados na anestesia balanceada de equinos, infusões contínuas de analgésicos e sedativos têm se mostrado úteis e eficazes nesta espécie. O cloridrato de lidocaína sob a forma de infusão contínua intravenosa apresenta efeito analgésico sistêmico, reduzindo de maneira intensa o requerimento de anestésicos gerais inalatórios, contribuindo também com seu efeito pró-cinético, melhorando o prognóstico em patologias do trato gastrointestinal. A presente revisão tem por objetivo descrever a literatura atual sobre a utilização do cloridrato de lidocaína por meio de infusão contínua intravenosa na espécie equina como parte de anestesia multimodal em procedimentos cirúrgicos para correção de síndrome cólica.

Background: Epidural block with local anaesthetic with or without additives is being used for perioperative analgesia. Various additives have been used to enhance the effect of regional blocks including epidural blocks. This study aimed to investigate the effect of adding a single shot epidural dexamethasone to bupivacaine on postoperative analgesia and dose of rescue analgesics used.Methods: A prospective, randomized, double blinded study was conducted in 90 adult patients undergoing lower abdominal surgery. The patients were randomized into two groups. Group 1 received 9ml of 0.5% bupivacaine plain with 1 ml of normal saline. Group 2 received 9ml of 0.5% bupivacaine plain 9 ml with 1 ml of dexamethasone (4mg). After standard balanced anesthesia technique, patients were observed in postoperative period for pain and hemodynamic variables accordingly.Results: Our study showed significantly longer duration of analgesia of 468 minutes (almost 8 hours) when dexamethasone was added to bupivacaine for single shot epidural injection compared to 271 minutes (approximately 4 and half hours) when bupivacaine alone was used (p<0.001). Consumption of rescue analgesic, Tramadol, was significantly lower in dexamethasone group in 24 hours (169.31±50.82 mg in Group 1 and 114.77±60.59mg in Group 2, p<0.001). No adverse events were noted.Conclusion: Addition of dexamethasone to bupivacaine for single shot epidural block almost doubled the duration of analgesia. Single shot epidural block using bupivacaine with addition of dexamethasone provides effective post operative analgesia and significantly reduced the postoperative rescue analgesic requirement.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 46-51

Background Surgical trauma induces nociceptive sensitization leading to amplification and prolongation of postoperative pain. While preemptive analgesic treatment with numerous agents has been successful in experimental animals, results of human studies remain conflicting. The authors used a multimodal approach for preemptive analgesia before abdominal surgery: diclofenac and metamizole inhibit prostaglandin synthesis, thus influencing peripheral sensitization; epidural local anesthetics induce conduction block, epidural opioids inhibit nociceptive synaptic transmission, and metamizole induces descending inhibition. The interaction of these drugs might suppress spinal nociceptive sensitization and postoperative analgesic demand. Methods One hundred forty-two patients scheduled for major abdominal surgery were randomly assigned to one of three groups and studied prospectively. Epidural catheters in groups 1 and 2 were placed at interspaces T8-T10, the position of the catheter was confirmed by epidurography, and sensory testing after administration of 5 ml mepivacaine 1%. Group 1 received 75 mg intramuscular diclofenac, 1000 mg intravenous metamizole, 5.3 +/- 1 mg epidural morphine, and 15-20 ml mepivacaine 1% 85 +/- 41 min before skin incision. Epidural analgesia was maintained by injections of 0.1 ml.kg-1.h-1 mepivacaine 1%. Group 2 patients received the balanced analgesia regimen before wound closure (221 +/- 86 min after skin incision). Group 3 patients did not receive any study substances. General anesthesia was induced with 5 mg/kg thiopental and 2 micrograms/kg fentanyl and maintained with enflurane and nitrous oxide. Postoperative analgesia consisted of patient-controlled intravenous morphine over 5 days. Results Median visual analog scale pain intensities were &lt; 3 cm and did not differ among the groups. Morphine consumption per hour on postoperative day 2 was 0.8 +/- 0.1 mg/h (group 1) &lt; 1.2 +/- 0.1 mg/h (group 2) = 1.1 +/- 0.1 mg/h (group 3) and cumulative morphine consumption (in mg) on the morning of day 5 was 95 +/- 9 (group 1) &lt; 111 +/- 11 (group 2) &lt; 137 +/- 10 (group 3). Conclusions A significant reduction of patient controlled analgesia requirements could be achieved by our preincisional balanced analgesia regimen compared to application before wound closure. The more distinct difference between patients receiving balanced analgesia and those in the control group is based on the analgesic action of the study substances, which lasted about 14 h.

Pain is a complex subjective experience comprising of both physical and emotional components. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of damage.”Opioids are essentially important constituent of balanced anaesthesia. They provide adequate analgesia, reduces requirement of inhaled anaesthetic agents, maintain cardiovascular stability and provide adequate post-operative analgesia. Morphine remains the most widely used analgesic and the gold standard against which all new opioids are compared. Butorphanol has been employed successfully for the relief of postoperative pain, labor pain, preanaesthetic medication and in balanced anaesthesia. We studied the analgesic property and the side effects of butorphanol and compared them with equipotent dose of morphine. This study revealed that butorphanol had more or less similar effects on haemodynamic parameters as compared to morphine. But butorphanol showed fewer side effects than morphine. This study suggested that patient compliance was on butorphanol.

Background This study evaluated the efficacy of an epidural single dose of neostigmine combined with sufentanil to provide selective and balanced analgesia at the beginning of labor. Methods After informed consent, 125 healthy parturients were randomly allocated to receive, after a test dose, a single injection of either epidural sufentanil 20 micrograms (minimal analgesic dose) or 10 micrograms or a combination of sufentanil 10 micrograms with neostigmine 250, 500, or 750 micrograms in a total volume of 12 ml. Pain scores were recorded at regular intervals to determine onset and duration of analgesia. Maternal and fetal vital parameters as well as side effects were closely monitored. Results Parturients did not differ concerning demographic data. Epidural neostigmine 500 micrograms with sufentanil 10 micrograms produced effective analgesia (visual analog scale &lt;30 mm within 10 min in 72% parturients and within 15 min in 85% parturients; average duration of 119 min, confidence interval 96-142 min) that was as effective as epidural sufentanil 20 micrograms. Epidural combination with neostigmine 250 micrograms was ineffective, whereas 750 micrograms did not produce higher effect than 500 micrograms. No motor block was recorded. Maternal and fetal vital parameters remained stable during labor. Conclusions Epidural combination of neostigmine 500 micrograms (e.g., 6-7 micrograms/kg) with sufentanil 10 micrograms provides similar duration of analgesia as epidural sufentanil 20 micrograms and allows effective and selective analgesia devoid of side effects in the first stage of labor.

Background: Visceral pain is the major component of pain after laparoscopic cholecystectomy. Periportal infiltration and peritoneal instillation of local anesthetics have been reported to be effective in various laparoscopic procedures. Aim of this study was to find out the analgesic effectiveness and duration of analgesia following combined intraperitoneal instillation and periportal infiltration of bupivacaine and to compare it with peritoneal instillation or periportal infiltration alone.Methods: A prospective, randomized, double blinded study was conducted in 90 adult patients undergoing elective laparoscopic cholecystectomy. The patients were randomized into three groups. Group 1 received intraperitoneal instillation of 20 ml of 0.5% bupivacaine. Group 2 received periportal infiltration of 10 ml of 0.25% bupivacaine. Group 3 received combination of both. After standard balanced anesthesia technique, patients were observed in postoperative period for pain and hemodynamic variables, that were recorded ½ hourly for 1 hour, then at 4, 8, 12 and 24 hours postoperatively. The time and doses for rescue analgesia, if given, were also recorded.Results: Combined peritoneal instillation and periportal infiltration provided a mean duration of analgesia of 6 hours. Peritoneal instillation alone provided analgesia for three hours while periportal infiltration alone provided analgesia for one hour. The combination group required one third (116.67 mg vs. 173.33 mg) less analgesic than periportal group and one fifth (116.67 mg vs. 148.33 mg) less than that of peritoneal group. No adverse effects were noted.Conclusion: Combined intraperitoneal instillation and periportal infiltration of bupivacaine reduced postoperative pain after laparoscopic cholecystectomy better than intraperitoneal instillation or periportal infiltration of bupivacaine alone.Journal of Society of Anesthesiologists 2014 1(2): 59-64

Balanced perioperative multimodal analgesia using multiple synergistic agents minimizes side effects that can be caused by high doses of only one aesthetic agent. The aim of the work was to determine the efficacy of perioperative multimodal low-opioid analgesia as anesthetic assurance techniques in aged and geriatric patients during cardiac surgery with cardiopulmonary bypass.Materials and methods. The study included 18 patients (11 (61.1%) men and 7 (38.9%) women) aged from 63 to 76 years old (mean age 69.5±6.2 years), who underwent coronary artery bypass grafting with cardiopulmonary bypass support. The average body weight was 89.6±13.9 kg (75 to 115 kg). The anaesthesia consisted of intravenous (iv) administration of propofol in a dose of 1.52±0.05 mg/kg and fentanyl in a dose of 1 μg/kg. Muscle relaxation was achieved by injecting pipecuronium bromide in a dose of 0.1 mg/kg. Sevoflurane inhalation was used to maintain anesthesia. Before making incision, the subnarcotic dose of ketamine (0.5 mg / kg) and lidocaine 1 mg/kg bolus were added with simultaneous administration of the continuous infusion of the latter in a dose of 1.5-2 mg/kg per hour. For postoperative analgesia ketorolac tromethamine was used. The intensity of the pain syndrome was assessed using a 10-point visual-analog scale of pain. The level of endocrine-metabolic response was determined by measuring the dynamics of lactate and cortisol.Results. The average dose of fentanyl, which was used for the patient during the whole time of anaesthesia, was 1.09±0.03 μg / kg per hour (on average 358.3±27.1 μg for all time of surgery). During the extracorporeal circulation and in the early postoperative period, the blood circulation parameters in all patients examined corresponded to the hemodynamic profile of the operated pathology. Positive verbal contact with patients was recorded in 18.6±3.4 minutes after the end of anaesthesia. The level of cortisol in the early postoperative period was 479.3±26.4 nmol/l. The average values of the intraoperative level of lactate were 1.61±0.2 mmol/l. The mean pain level in the first postoperative day in the examined patients was 4.6 ± 1.2 (3-6) scores by VAS, one day after the operation – 2.6±1.1 (1.5-4) scores by the VAS.Conclusions. Multimodal low-opioid analgesia provides an adequate analgesic effect in aged and geriatric patients that is confirmed by the absence of hemodynamic and endocrine-metabolic disorders. The use of ketorolac as a component of multimodal low-opioid analgesia is an effective method for achieving adequate postoperative analgesia and contributes to reducing the side effects associated with the use of narcotic analgesics.

El dolor postoperatorio es el máximo representante del dolor agudo y se define como un dolor de inicio reciente, duración probablemente limitada y que aparece como consecuencia de la estimulación nociceptiva resultante de la intervención quirúrgica sobre los distintos órganos y tejidos. La característica mas destacada del dolor postoperatorio es que su intensidades máxima es en las primeras 24 horas y disminuye progresivamente.

Made available in DSpace on 2016-01-26T18:55:39Z (GMT). No. of bitstreams: 1 Giulianne.pdf: 642952 bytes, checksum: b1065f2a240f35cc8466ace402a0ed40 (MD5) Previous issue date: 2014-03-31
The aim of this study was to evaluate the analgesic effects of gabapentin as an adjunct in the control of postoperative pain in dogs undergoing mastectomy. In a blinded study, 20 female dogs (10.5±5 kg body weight) were randomly assigned to 2 groups of 10 animals each and received 60 min prior of the surgery, by oral route: 10mg kg-1 of gabapentin (Gabapentin) or placebo (Control). Pre-anesthetic medication was intramuscular (IM) acepromazine (0.03mg kg-1) in combination with morphine (0.3mg kg-1). Anesthesia was induced with intravenously (IV) propofol (dose effect) and maintained with isoflurane. Meloxicam (0.2 mg kg-1, IV) was administered five minutes before the surgical incision. The analgesic intra-operative support was provided by IV continuous rate morphine (0.1mg kg-1h-1). Heart rate, respiratory rate, systolic arterial blood pressure, oxycapnography and end-tidal concentration of isoflurane were evaluated during the surgery. Postoperative analgesia was assessed during the first 72 hours after the tracheal extubation using a Dinamic and Interative Visual Analog Scale (DIVAS) and modified Glasgow Composite Measure Pain Scale (modified-GCMPS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of DIVAS and/or 33% of GCMPS during the postoperative period. The cardiopulmonary variables, pain and sedation scores did not differ between groups. However, rescue analgesia was 40% less frequently for Gabapentin (6 of 10 dogs needs rescue analgesic, total of 9 rescued doses in the Gabapentin group) than in the Control group (8 of 10 dogs, total of 15 rescued doses in the Control group). It was concluded that the adjuvant gabapentin administration reduce the requirement for rescue opioid in dogs undergoing mastectomy
Objetivou-se avaliar a ação da gabapentina como adjuvante do controle da dor pós-operatória em cadelas encaminhadas à mastectomia. Foram avaliadas 20 cadelas, com peso médio de 10,5±5, distribuídas em dois grupos de dez animais cada: Gabapentina: tratamento com gabapentina (10mg kg-1) por via oral, 60 minutos antes da cirurgia, seguindo-se a administração da mesma dose a cada 24 horas, durante três dias subsequentes à cirurgia; Controle: tratamento placebo, administrado conforme descrito para o tratamento Gabapentina. Todos os animais foram tranquilizados com acepromazina (0,03mg kg-1), em associação à morfina (0,5mg kg-1), por via intramuscular. Vinte minutos após, foi iniciada a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1), que foi mantida até o término do procedimento cirúrgico. A indução e manutenção anestésicas foram realizadas com propofol (dose efeito, IV) e isofluorano, respectivamente. Meloxicam (0,2mg kg-1, IV), foi administrado cinco minutos antes da incisão cirúrgica. Durante o procedimento anestésico foram avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia, temperatura retal, concentração final inspirada e expirada de isofluorano. No período pós-operatório o grau de analgesia foi mensurado 30 minutos, 1, 2, 4, 8, 12, 18, 24, 32, 40, 48, 56, 64 e 72 horas após extubação traqueal utilizando-se a Escala Analógica Visual Interativa e Dinâmica (EAVID) e a Escala Composta de Glasgow Modificada (ECGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% do EAVID e/ou 33% do ECGM. O grau de sedação foi avaliado por sistema de escore. As variáveis cardiorrespiratórias e os escores de dor e de sedação não diferiram entre os tratamentos. Porém, no período pós-operatório, analgesia de resgate foi 40% menos frequente no grupo Gabapentina (6 de 10 cães necessitaram de resgate analgésico, totalizando 9 resgates no grupo Gabapentina) em relação ao Controle (8 de 10 cães necessitaram de resgate analgésico, totalizando 15 resgates no grupo Controle). Conclui-se que a administração adjuvante da gabapentina reduziu o requerimento de morfina para controle da dor no período pós-operatório em cadelas pós-mastectomia

Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-18T02:10:00Z No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-18T03:16:11Z (GMT) No. of bitstreams: 4 Projeto Final_Christiane.doc: 14882816 bytes, checksum: 6f2443d86ff0e57a5ff5fc5c601ed125 (MD5) Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Rejected by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br), reason: O Documento deve estar no formato PDF. Retorne ao sistema e faça o upload de uma versão neste formato. Dúvidas: ddbc@ufam.edu.br on 2018-10-18T12:29:56Z (GMT)
Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T03:06:49Z No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Rejected by PPGRACI Cirurgia (ppgraci@ufam.edu.br), reason: Já foi aceita a submissão da dissertação, na língua portuguesa, com abstract em inglês. Ressubmissão com o título do documento em inglês cria a expectativa que toda a dissertação foi traduzida, o que não ocorre com esta nova submissão. on 2018-10-19T16:11:42Z (GMT)
Submitted by Christiane Rodrigues da Silva (christianerdasilva@ufam.edu.br) on 2018-10-19T17:01:37Z No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by PPGRACI Cirurgia (ppgraci@ufam.edu.br) on 2018-10-19T17:54:31Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-10-19T18:22:40Z (GMT) No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)
Made available in DSpace on 2018-10-19T18:22:40Z (GMT). No. of bitstreams: 4 Carta de encaminhamento para Autodepósito.pdf: 331385 bytes, checksum: 531c27ef5d65302d431d11bc3a7d8924 (MD5) Ata da Defesa Pública.pdf: 879468 bytes, checksum: 070af76dbbeb551e87bd807f93302c3a (MD5) Projeto Final_Christiane.pdf: 5105546 bytes, checksum: 7e363fd433154b9aacfad042f4d44b0e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-09-21
BACKGROUND. Untreated pain leads to postoperative complications that prolong hospital stay. The association of analgesic drugs with different mechanisms of action, such as clonidine, allows the use of smaller doses of medication for better control of pain. OBJECTIVES. This dissertation aims to evaluate the use of multimodal analgesia in the control of postoperative pain in patients submitted to videolaparoscopic cholecystectomy (VLC); to compare the analgesic activities of intrathecal and intravenous clonidine for postoperative analgesia; to analyze the need for analgesic drugs in the immediate postoperative (tramadol / morphine) and to identify possible complications. METHOD. A prospective, randomized clinical trial was conducted with patients divided into three blocks, with 20 patients each one: Group I (n = 20) control, submitted to standard anesthesia; Group II (n = 20) intrathecal clonidine, submitted to standard anesthesia associated with the use of intrathecal clonidine; Group III (n = 20) intravenous clonidine, submitted to standard anesthesia associated with the use of intravenous clonidine. RESULTS. The pain scores between the groups did not present significant differences, but a greater analgesic need was observed in the control group (p = 0.005), as well as a higher incidence of nausea and vomiting (p = 0.240), probably due to side effects of morphine as rescue medication. Groups II and III presented a significant reduction of heart rate (p ˂ 0.001), but without clinical repercussion. CONCLUSIONS. In patients undergoing VLC there is evidence that the perioperative administration of alpha 2-agonists preserves hemodynamic stability, decreases opioid consumption and the incidence of nausea and vomiting in the postoperative.
JUSTIFICATIVA. A dor não tratada leva a complicações pós-operatórias que prolongam o tempo de internação hospitalar. A associação de fármacos analgésicos com diferentes mecanismos de ação, como a clonidina, permite usar doses menores de medicamentos para melhor controle da dor. OBJETIVOS. Esta dissertação tem por objetivo avaliar o emprego de analgesia multimodal no controle da dor pós-operatória de pacientes submetidos à colecistectomia por videolaparoscopia (CVLP); comparar as atividades analgésicas da clonidina intratecal e endovenosa para analgesia pós-operatória; analisar a necessidade de drogas analgésicas no pós-operatório imediato (tramadol/morfina) e identificar possíveis complicações. MÉTODO. Foi realizado um estudo de ensaio clínico prospectivo, experimental e randômico, com os pacientes divididos em 03 blocos, com 20 pacientes cada: Grupo I (n=20) controle, submetido à anestesia padrão; Grupo II (n=20) clonidina intratecal, submetido à anestesia padrão associada ao uso de clonidina intratecal; Grupo III (n=20) clonidina endovenosa, submetido à anestesia padrão associada ao uso de clonidina endovenosa. RESULTADOS. Os escores de dor entre os grupos não apresentaram valores com diferenças significativas, porém foi observada maior necessidade analgésica do uso da morfina no grupo controle (p = 0,005), assim como maior incidência de náuseas e vômitos (p=0,240), provavelmente devido aos efeitos colaterais da morfina como medicação de resgate. Os grupos II e III apresentaram uma redução significativa da frequência cardíaca (p ˂0,001), porém sem repercussão clínica. CONCLUSÕES. Nos pacientes submetidos à CVLP há evidências de que a administração perioperatória de alfa 2-agonistas preserva a estabilidade hemodinâmica, diminui o consumo de opióides e a incidência de náuseas e vômitos no pós-operatório.

INTRODUCCION: Debido al desarrollo de nuevas técnicas quirúrgicas y a la necesidad de reducir la estancia hospitalaria en cirugías ambulatorias como la colecistectomía laparoscópica así como para disminuir el efecto adverso de opioides y debido a la evidencia actual que sugiere que el uso de dosis pequeñas de ketamina proporcionan una mejor analgesia surge el interés por el uso de este medicamento administrado por vía IV en pacientes sometidos a este tipo de intervención para investigar sus efectos hemodinámicos y si su uso como analgésico puede mejorar la calidad de la analgesia postoperatoria OBJETIVO: Comprobar que los pacientes que reciben Ketamina-ketorolaco IV transoperatoria tienen menor calificación en la EVA del dolor sin repercusión hemodinámica importante que los pacientes que solo reciben placebo-ketorolaco IV cuando son sometidos a colecistectomía laparoscópica bajo AGB MATERIAL Y MÉTODO: Prolectivo, longitudinal, comparativo. Se estudiaron 50 pacientes programados electivamente para colecistectomía laparoscópica RESULTADOS: Se encontraron diferencias significativas en la FC y TAM a los 30 y 60 minutos postoperatorios en el grupo ketamina-ketorolaco con respecto al grupo placebo-ketorolaco. La duración de la analgesia postoperatoria en el grupo ketamina-ketorolaco fue mayor que en el grupo placebo-ketorolaco. El puntaje de EVA del dolor fue menor en el grupo ketamina-ketorolaco a los 60 min postoperatorios, el grupo que recibió placebo-ketorolaco recibió más dosis de rescate de Tramadol que el grupo ketamina-ketorolaco y aunque la diferencia estadística no fue significativa la significancia clínica fue evidente. No se encontraron efectos adversos hemodinámicos en ambos grupos. CONCLUSIONES: La administración de dosis de ketamina-ketorolaco IV durante el transanestésico de colecistectomía laparoscópica incrementa la duración de la analgesia postoperatoria. La administración de este esquema transoperatorio es eficaz y seguro al no tener efectos hemodinámicos severos durante el transanestésico pudiendo ser una alternativa como coadyuvante analgésico

Preemptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics. Several advances have been made in our understanding of pain signaling pathways, which have since enabled caregivers to treat pain using a multimodal (or “balanced”) approach to providing adequate pain relief while minimizing side effects. This allows for a reduction in the doses of individual drugs and thus a lower incidence of adverse effects from any particular medication used for analgesia.

Regional anesthesia and analgesia provide attractive options for patients undergoing major orthopedic procedures. The use of anticoagulation medications in the elderly patient population and in patients with cardiovascular risks is very common. The guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and other societies have been adopted widely over many years. The guidelines provide a basis for adequate delay intervals between dosing of medications and performing neuraxial or peripheral nerve blocks (PNBs), thus allowing for safer practice of regional anesthesia. Following guidelines never eliminates risk, but it allows balanced clinical practice by physicians in regard to the risks and benefits for individual patients.

This chapter describes patients undergoing total shoulder arthroplasty (TSA), who often present an array of challenging considerations regarding anesthetic management and perioperative pain control. Unlike in other types of shoulder surgery, patients undergoing TSA often have more significant comorbidities such as advanced age and morbid obesity that can affect outcomes in the perioperative period. Preoperative screening should be performed to allow adequate planning for the day of surgery and to ensure adequate postoperative monitoring. Because the procedure is an open surgical approach, it can be very stimulating, and extra consideration for perioperative analgesia should be taken. Careful consideration of multimodal (balanced) analgesic modalities to account for potential respiratory compromise, and incorporation of regional anesthetic modalities can contribute to successful delivery of anesthesia and safe recovery thereafter.

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

Obese patients present unique challenges to the anaesthesiologist, requiring careful management of neuromuscular blockade to facilitate intubation, optimize surgical conditions, and ensure safe recovery of patients. Neuromuscular blockade is a key component of the balanced anaesthesia technique initially identified by Cecil Gray and colleagues and termed the Liverpool technique—a triad of unconsciousness, analgesia, and muscle relaxation. Furthermore, monitoring of blockade prior to reversal will allow the anaesthesiologist to select the appropriate reversal agent and correct dosage. Confirmation of recovery of the train-of-four ratio to greater than 0.9 prior to extubation will reduce the adverse effects associated with residual neuromuscular blockade that may be exacerbated in the obese patient. This chapter reviews neuromuscular blocking agents, monitoring of neuromuscular blockade, and reversal agents. This will optimize the management of neuromuscular blockade to improve safety and outcomes in the obese patients.

This chapter discusses scoliosis repair, one of the most common major orthopedic surgeries performed in pediatric patients. Adolescent idiopathic scoliosis is the most common form and affects 1% to 3% of children and adolescents between the ages of 10 and 16. The anesthetic management of these patients can be challenging due to potential physiologic derangements that may be present. Adequate perioperative pain management is crucial, given the potential for significant postoperative and chronic pain conditions following repair. The rate of chronic postsurgical pain following scoliosis repair in pediatric patients averages about 20%. A balanced approach to analgesic management is best utilized to optimize pain relief while limiting side effects. Proper preparation for the perioperative experience, including setting expectations and planning for pain management, is a key factor in a successful recovery.