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Barros, Guilherme Antonio Moreira de. "Considerações sobre analgesia controlada pelo paciente (PCA) em hospital universitário /". Botucatu : [s.n.], 2001. http://hdl.handle.net/11449/86638.
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Orientador: Lino LemonicaResumo: Com o rápido avanço que foi observado nos últimos anos nas técnicas cirúrgicas e anestésicas, os procedimentos se tornaram cada vez mais invasivos. Como houve progressivo envelhecimento da população, o período mais delicado de recuperação, ou seja, o pós-operatório, passou a receber maior atenção. O surgimento de novas técnicas de analgesia, como a Analgesia Controlada pelo Paciente (PCA), vem preencher as necessidades da comunidade médica, cada vez mais atenta à qualidade dos serviços prestados. O Hospital de Clínicas da Faculdade de Medicina da UNESP, Botucatu, atento a essa nova realidade constituiu o Serviço de Dor Aguda (SEDA) para que esta lacuna fosse também preenchida em nosso meio. No intuito de identificar a atuação do SEDA, realizou-se levantamento, de fevereiro de 1995 a dezembro de 1997, com a pesquisa das evoluções de 679 pacientes seguidos pelo SEDA e que fizeram uso do método PCA de analgesia. Observou-se que os resultados obtidos pelo Serviço estavam acima da média relatada pela literatura internacional, com excelentes níveis de analgesia atingidos, baixa ocorrência de efeitos colaterais, e nenhuma complicação fatal no período do estudo.
Abstract: In the past years a fast developing has been observed in the surgery and anesthetic technique, with more invasive procedures being performed. As the general population has becoming older, the critical recovery period, it means the post surgery period, became focus of attention. The developing of new analgesia techniques, such as Patient Controlled Analgesia (PCA), has the intention of fulfill the needs of the medical community, day by day more aware about the quality of the services. The Hospital of the Sao Paulo State Medical School, Botucatu, aware of this new reality had decided to form the Acute Pain Management Service (SEDA). With the goal of identify the way the SEDA acts this research was realized in period between February, 1995, to December, 1997. Data of 679 patients who used the PCA device were evaluated. The results in this study were as good as the international literature shows, with high quality analgesia, low side effects and no fatal complications on the period observed.
Mestre
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Barros, Guilherme Antonio Moreira de [UNESP]. "Considerações sobre analgesia controlada pelo paciente (PCA) em hospital universitário". Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/86638.
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barros_gam_me_botfm.pdf: 228323 bytes, checksum: 6466d10f0d4eb9a3ff79e8f785fea941 (MD5)Com o rápido avanço que foi observado nos últimos anos nas técnicas cirúrgicas e anestésicas, os procedimentos se tornaram cada vez mais invasivos. Como houve progressivo envelhecimento da população, o período mais delicado de recuperação, ou seja, o pós-operatório, passou a receber maior atenção. O surgimento de novas técnicas de analgesia, como a Analgesia Controlada pelo Paciente (PCA), vem preencher as necessidades da comunidade médica, cada vez mais atenta à qualidade dos serviços prestados. O Hospital de Clínicas da Faculdade de Medicina da UNESP, Botucatu, atento a essa nova realidade constituiu o Serviço de Dor Aguda (SEDA) para que esta lacuna fosse também preenchida em nosso meio. No intuito de identificar a atuação do SEDA, realizou-se levantamento, de fevereiro de 1995 a dezembro de 1997, com a pesquisa das evoluções de 679 pacientes seguidos pelo SEDA e que fizeram uso do método PCA de analgesia. Observou-se que os resultados obtidos pelo Serviço estavam acima da média relatada pela literatura internacional, com excelentes níveis de analgesia atingidos, baixa ocorrência de efeitos colaterais, e nenhuma complicação fatal no período do estudo.
In the past years a fast developing has been observed in the surgery and anesthetic technique, with more invasive procedures being performed. As the general population has becoming older, the critical recovery period, it means the post surgery period, became focus of attention. The developing of new analgesia techniques, such as Patient Controlled Analgesia (PCA), has the intention of fulfill the needs of the medical community, day by day more aware about the quality of the services. The Hospital of the Sao Paulo State Medical School, Botucatu, aware of this new reality had decided to form the Acute Pain Management Service (SEDA). With the goal of identify the way the SEDA acts this research was realized in period between February, 1995, to December, 1997. Data of 679 patients who used the PCA device were evaluated. The results in this study were as good as the international literature shows, with high quality analgesia, low side effects and no fatal complications on the period observed.
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Pinheiro, Marcos Luciano Pimenta. "Infiltração submucosa intrabucal de betametasona na previsão ou controle da dor em endodontia". [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290791.
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Orientador: Eduardo Dias de AndradeTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A dor pós-operatória decorrente de procedimentos endodônticos ainda se constitui numa grande preocupação do cirurgião-dentista.O objetivo desta pesquisa foi avaliar os efeitos da betametasona na prevenção ou controle da dor pós-operatória, em duas situações distintas: na primeira etapa ('E IND. 1¿), a prevenção da dor decorrente de tratamentos endodônticos eletivos, em sujeitos previamente assintomáticos;na segunda fase ('E IND. 2¿), o controle da dor já estabelecida,no caso das urgências endodônticas. Foram selecionados 102 voluntários em bom estado de saúde geral para a 'E IND. 1¿ e 120 sujeitos para a 'E IND. 2¿, que receberam os seguintes tratamentos: injeção infiltrativa de uma solução de betametasona (0,05 mg/Kg de peso corporal) ou placebo (solução salina, num volume equivalente), administrada pela via submucosa, na face vestibular da região apical do dente envolvido, imediatamente após o final da intervenção, de forma aleatória e duplo-cega. A intensidade de dor foi avaliada por meio de escalas verbais descritivas, nos tempos de 4, 24 e 48 horas após o tratamento, por contato telefônico. Os dados foram tratados estatisticamente pelos testes Exato de Fischer, Mann-Whitney e Qui-quadrado ('alfa¿=5%), demonstrando que na primeira etapa, a intensidade de dor pós-operatória foi significativamente menor nos pacientes tratados com a betametasona, em relação ao placebo, nos 3 tempos de estudo (4 horas: p = 0,0007, 24 horas: p = 0,0022, 48 horas: p = 0,0126). Na segunda etapa, o controle da dor também foi mais eficaz no grupo tratado com a betametasonanos tempos de 4 horas (p = 0,0177) e 24 horas (p = 0,0012), se comparado ao placebo. Com base no conceito de que a dor decorrente da instrumentação em endodontia é, de forma geral, de maior intensidade nas primeiras 24 horas após o procedimento, conclui-se que a betametasona pode ser indicada como terapia adjuvante aos procedimentos clínicos de ordem local, tanto nos tratamentos eletivos quanto nas urgências endodônticas
Abstract: Posttreatment endodontic pain is still a significant problem in dentistry. The aim of this randomized double-blind study was to evaluate, in two stages, the effect of betamethasone on the control of postoperative pain in patients submitted to endodontic treatment. In the first stage, patients were asymptomatic, whereas in the second, pain was already present before the treatment. Volunteers (n=102), both genders, were submucosally injected with a single dose of a betamethasone solution (0.05 mg/body weight) or a sterile saline solution (placebo) after endodontic treatment completion. All volunteers received a vestibular injection periapically to the tooth treated. To assess pain intensity, verbal descriptive scales were given to all volunteers. Answers were given from their homes by telephone at 4, 24, and 48 hours afier endodontic treatment. The Chi-square, Mann-Whitney and Fischer's exact tests were used for statistical analysis. In the first stage, pain intensity was significantly lower for patients treated with betamethasone in the three periods tested (4 hours: p=0.0007;24 hours: p=0.0022; 48 hours: p=0.0126), when compared to placebo. In the second stage, pain was also better controlled by betamethasone at periods of 4 hours (p=0.0177) and 24 hours (p=0.0012) for patients treated with betamethasone, when compared to placebo. In conclusion, once the pain caused by endodontic instrumentation is in general more intense at the first 24 hours after treatment, betamethasone might be used as an adjuvant therapy to pain control in endodontic procedures
Doutorado
Farmacologia, Anestesiologia e Terapeutica
Doutor em Odontologia
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Oliveira, Angelica Arantes Silva de. "Práticas assistenciais neonatais no controle da dor pós-operatória". Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-23062010-093943/.
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Introdução: O tratamento da dor pós-operatória neonatal é um desafio aos profissionais de saúde. A dor pós-operatória é causada por trauma tissular do procedimento cirúrgico, pela manipulação de dispositivos invasivos instalados para monitorar os sinais vitais e auxiliar na recuperação do neonato, dentre outras causas. Objetivo: Descrever as práticas assistenciais de controle da dor pós-operatória neonatal implementadas em uma unidade de terapia intensiva neonatal de um hospital escola situado na cidade de São Paulo. Método: Estudo transversal retrospectivo realizado na Unidade de Cuidados Intensivos Neonatais com 43 recém-nascidos no período pós-operatório, internados entre julho de 2008 a junho de 2009. Os dados das primeiras 72 horas pós-operatórias foram obtidos dos prontuários e do instrumento Controle da Dor Pós-Operatória Neonatal. No instrumento, a enfermeira registra a avaliação da dor, sua ocorrência, tratamento farmacológico e não-farmcológico; foi instituído visando a proporcionar controle sistematizado, alívio da dor e conforto. Resultados: Dos 43 neonatos inclusos no estudo, cinco foram submetidos a mais de uma cirurgia no período neonatal precoce, totalizando 50 intervenções cirúrgicas analisadas. A maioria dos neonatos, 55,8%, nasceu a termo, apresentou média de 5,9 dias de idade cronológica e média de peso de 2.495,6 gramas na data da cirurgia. Os diagnósticos pré-operatórios mais frequentes foram os relacionados às anomalias do sistema digestório: gastrosquise (41,8%) e atresia de esôfago (18,6%). Mantinham três ou mais dispositivos instalados no pós-operatório imediato (POI) 84,0% neonatos, no primeiro pós-operatório (1ºPO) 86,0%, e no segundo pós-operatório (2ºPO) 79,2% neonatos. O procedimento de aspiração da cânula orotraqueal e das vias aéreas superiores foi realizado em 78,0% dos neonatos no POI, em 64,0% dos neonatos no 1ºPO e em 50,0% dos neonatos no 2ºPO. As frequências de ocorrência da dor pós-operatória, com indicação de analgesia (pontuação CRIES 5) foram verificadas em 50,0% dos neonatos no POI, em 40,0% dos neonatos no 1º PO e, em 27,0% dos neonatos no 2ºPO. Fármacos analgésicos foram administrados em 96,0%, 98,0% e 89,6% dos neonatos durante os POI, 1ºPO e 2ºPO, respectivamente. Dipirona intravenosa intermitente foi administrada de forma isolada ou associada a outro analgésico em 86,0%, 90,0% e 81,2% neonatos nos POI, 1ºPO e 2ºPO, respectivamente. A todos os neonatos foram proporcionadas medidas não-farmacológicas isoladas ou combinadas, visando a prevenir ou aliviar a dor. O aninhamento foi o método de escolha, em especial, nos POI e 1ºPO. A ocorrência da dor aguda foi identificada (pontuação NIPS 3) antes e após procedimentos invasivos e verificou-se intensificação da resposta dolorosa. Conclusão: A ocorrência da dor foi observada no pós-operatório a despeito do uso de analgésicos. Os resultados sugerem que, além da sistematização das avaliações da dor, a utilização de protocolos de analgesia farmacológica e não-farmacológica, no período pós-operatório neonatal, constituem medidas necessárias.Introduction: The postoperative pain treatment in neonates is challenging for the health care professionals. Postoperative pain is caused by tissue trauma related to the surgery, by manipulation of devices used to monitor vital signs and to facilitate the recovery of the neonates, amongst others causes. Objective: To describe the care practices for controlling postoperative pain in a terciary Neonatal Intensive Care Unit (NICU) of a teaching hospital located at the city of São Paulo. Method: Retrospective cross-sectional study, conducted at the NICU, which enrolled 43 postsurgical neonates between July 2008 to June 2009. Data were extracted from the medical records of each infant and from the Postoperative Pain Management Form regarding the first 72 hours of postoperative period. The form is completed by the nursing team with the following information: pain assessment episodes, pain occurrence and pharmacological and non-pharmacological methods provided for pain relief and comfort. Results: From the 43 neonates enrolled, five underwent two surgeries in the early neonatal period. Thus, the medical records of 50 infants during the first 72 hours of postoperative period were analyzed. The majority of the newborns (55.8%) was full term, mean postnatal age 5.9 days and mean weight 2495.6 grams on the day of the surgery. The majority of the infants had preoperative diagnoses related to the digestive system anomalies, such as gastroschisis (41.8%) and esophageal atresia (18.6%). Most of the neonates had three or more devices installed in the immediate post-operative period (IPO), 84.0%; during the first postsurgical day (1st PO), 86.0%, and during the second postsurgical day (2nd PO), 79.2%. Tracheal tube suctioning and upper airway suctioning were performed in 78.0% of the newborns during the IPO, in 64.0% newborns in the 1st PO and 50.0% of the neonates on the 2nd PO. The frequency of postoperative pain occurence and need of analgesia (CRIES scores 5) was observed in 50.0% (IPO), 40.0% (1st PO) and 27.0% (2nd PO) neonates. Pharmacological analgesia was administered to 96.0%, 98.0% and 89.6% of the infants during IPO, 1st and 2nd PO, respectively. Intermittent intravenous Dipyrone was administered alone or combined with another analgesic or sedative in 86.0%, 90.0% and 81.2% of the neonates in the IPO, 1st PO and 2nd PO, respectively. All infants received non-pharmacological interventions, alone or combined, to prevent or relieve pain. \"Nesting\" was the method of choice, especially during the IPO and 1st PO. The occurrence of acute pain was assessed (NIPS scores 3) before and after invasive procedures and pain responses after the procedures were intensified. Conclusion: The occurrence of pain was observed in the postoperative period despite the use of analgesics. Results suggest that using pharmacological analgesia protocols and non-pharmacological treatment for postoperative pain combined to systematic pain assessments is necessary.
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Nunes, Alex Barbosa. "Estudo dos acupontos estômago 6 e estômago 7 no controle álgico da pulpite irreversível sintomática". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/23/23139/tde-19092014-161743/.
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O termo odontalgia engloba várias doenças dentárias capazes de causar dor, entre elas a pulpite irreversível sintomática (PIS), caracterizada por um pico inflamatório que afeta irreversivelmente as células da polpa dental, gerando uma dor excruciante. Os medicamentos são capazes de gerar analgesia parcial, porém com uma parcela de efeitos colaterais e contraindicações. O tratamento definitivo é realizado preferencialmente através da pulpectomia ou na impossibilidade, através da exodontia. A acupuntura apresenta poucas contraindicações, baixo risco e efetividade analgésica comprovada em diversas condições álgicas. De acordo com os livros texto, vários pontos de acupuntura apresentam efetividade analgésica nas odontalgias, entre elas a PIS. Entretanto, não foram encontrados estudos que suportassem essas conclusões. Assim, o objetivo desse estudo é verificar a existência de tendência de analgesia da acupuntura através de dois pontos de fácil acesso e aplicação: estomago 6 (ST6) e estômago 7 (ST7), em indivíduos portadores exclusivamente de PIS, em apenas um dente. O estudo foi realizado no Serviço de Urgências Odontológicas da FOUSP, seguindo delineamento cross-over em sessão única, randomizado e duplo-cego. Observa-se que os pontos ST6 e ST7 apresentam tendência a reduzir a dor da PIS independentemente de serem utilizados antes ou depois de seu respectivo placebo. Desponta-se assim a necessidade de mais estudos que confirmem essa eficácia, de forma a possibilitar a indicação precisa e o alento para os portadores de uma das odontalgias mais intensas que se tem conhecimento.The term odontalgia emcompasses several diseases capable to cause pain, including symptomatic irreversible pulpitis (SIP), characterized by an inflammatory peak which irreversibly affects the cells of the dental pulp, causing excruciating pain. The drugs are capable of generating partial analgesia, but with a quota of side effects and contraindications. The definitive treatment is preferably carried out by pulpectomy, or on the inability of it, through the exodonty. Acupuncture has few contraindications, low risk and proven analgesic efficacy in several algic conditions. According to the textbooks, many acupuncture points bring forward analgesic effectiveness in odontalgias, including the SIP. However, no studies that supported these conclusions were found. The aim of this study is to verify the existence of propensity of acupuncture analgesia through two points of easy access and application: stomach 6 (ST6) and stomach 7 (ST7), exclusively in individuals of SIP in just one tooth. The study was conducted in the Department of Emergency Dental FOUSP, following cross-over design in a single session, randomized, double-blind. It is observed that ST6 and ST7 points have a tendency to reduce the pain of SIP whether used before or after the respective placebo. Thus it suggests the need for further studies confirming its effectiveness, in order to enable the precise diagnostic and the breath for patients with one of the most intense odontalgias that are known.
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Leite, Ceci Ribeiro. "Efeitos da injeção epidural de metadona no controle da dor pós-incisional em equinos". reponame:Repositório Institucional da UnB, 2010. http://repositorio.unb.br/handle/10482/7062.
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Dissertação (mestrado)–Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, 2010.Submitted by Shayane Marques Zica (marquacizh@uol.com.br) on 2011-02-24T18:20:52Z No. of bitstreams: 1 2010_CeciRibeiroLeite.pdf: 1056843 bytes, checksum: 8756eba53ce6adbbbf188d97e1ca3f71 (MD5)
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O presente estudo teve como objetivo avaliar a eficácia analgésica e efeitos sistêmicos da metadona comparada à cetamina, quando administrada por via epidural em equinos. Foram utilizados 15 animais adultos, 10 fêmeas e cinco machos, sem raça definida, com idades variando de 4 a 10 anos com massas de 287 ± 37kg, distribuídos em três grupos de cinco animais cada. Foi realizada uma incisão atingindo pele e tecido subcutâneo na região caudal da coxa direita de cada animal. Cerca de 60 minutos depois, os equinos receberam injeções epidurais de metadona (0,1mg.kg-1), cetamina (1,0 mg.kg-1) ou solução de NaCl 0,9% (salina), sendo o volume total (VT) da injeção, nos três grupos, calculado segundo a fórmula: VT = 3,4mL + (peso em kg x 0,013) e completado com solução salina. Os parâmetros aferidos foram: frequência cardíaca (FC), frequência respiratória (f), temperatura retal (TR) e pressão arterial sistólica (PAS), além da avaliação do limiar nociceptivo, mensurado por meio de estimulação mecânica com os filamentos de von Frey. Todos os parâmetros foram avaliados a cada 15 minutos na primeira hora após a injeção epidural, a cada 30 minutos nas próximas 3 horas, a cada 2 horas nas 8 horas subsequentes e depois às 18 e 24 horas após a injeção. Tanto a metadona quanto a cetamina promoveram analgesia, porém a metadona apresentou período de latência mais curto (15 minutos versus 45 minutos do grupo cetamina) e analgesia mais intensa e duradoura (até 195 minutos, enquanto no grupo cetamina durou até 135 minutos). Além disso, clinicamente a metadona apresentou efeito analgésico superior ao da cetamina promovendo limiares mais altos em 85,5% dos tempos de avaliação, enquanto a cetamina foi superior à metadona apenas em 10,5% dos tempos. A analgesia promovida por ambos os fármacos foi equivalente em 4% dos tempos de avaliação. Não houve alterações na FC, f, ou PAS em nenhum dos grupos. A TR se elevou dos 210 aos 720 minutos nos três grupos. O grupo que recebeu cetamina apresentou alto índice de ataxia (80%). A metadona na dose de 0,1mg.kg-1 por via epidural não gerou efeitos adversos em equinos e promoveu analgesia significativa, sendo indicada como opção para o tratamento da dor inflamatória nesta espécie. _______________________________________________________________________________________ ABSTRACT
This study aimed to evaluate the analgesic efficacy and systemic effects of methadone compared to ketamine when administered via epidural injection in horses. A total of 15 adult crossbreed animals, ten female and five male, aged 4 to 10 years old, weighting 287 ± 37kg were separated in three groups of five animals each. A skin and subcutaneous tissue incision was performed in the caudal region of the right thigh of each animal. About 60 minutes later, the horses received epidural injections of methadone (0.1 mg.kg-1), ketamine (1.0 mg.kg-1) or 0.9% NaCl solution (saline), and the total volume (TV) of the injections in the three groups was calculated by the formula: TV = 3.4 mL + (weight in kg x 0.013) and completed with saline. The parameters measured were: heart rate (HR), respiratory rate (RR), rectal temperature (RT) and systolic arterial pressure (SAP), besides the evaluation of nociceptive threshold, measured by means of mechanical stimulation with von Frey filaments. All parameters were evaluated every 15 minutes during the first hour after epidural injection, every 30 minutes in the next three hours, every two hours in the subsequent eight hours and then at 18 and 24 hours after injection. Both ketamine and methadone promoted analgesia, but methadone showed shorter latency period (15 minutes versus 45 minutes of the ketamine group) and more intense and long lasting analgesia (up to 195 minutes, while in the ketamine group lasted until 135 minutes). Furthermore, methadone showed clinically superior analgesic effect than ketamine, promoting higher thresholds in 85.5% of the times assessed, while ketamine was superior to methadone only in 10.5% of the times. The analgesic effects of both drugs was equivalent in 4% of the evaluation times. There were no significant changes in HR, RR or SAP in either group. The RT has risen from 210 to 720 minutes in all groups. The group that received ketamine had a high rate of ataxia (80%). Methadone (0.1 mg.kg-1) via epidural injection did not generate adverse effects in horses and promoted significant analgesia being indicated as an option for the treatment of inflammatory pain in this species.
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Crociolli, Giulianne Carla. "Gabapentina como adjuvante no controle da dor pós-operatória em cadelas submetidas à mastectomia". Universidade do Oeste Paulista, 2014. http://bdtd.unoeste.br:8080/tede/handle/tede/293.
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Previous issue date: 2014-03-31The 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
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Marques, Virgínia Ines Moreira. "LASER ACUPUNTURA VERSUS ELETROACUPUNTURA PARA O CONTROLE DA DOR PÓS-OPERATÓRIA EM GATAS SUBMETIDAS À OVARIOSALPINGOHISTERETOMIA". Universidade do Oeste Paulista, 2015. http://bdtd.unoeste.br:8080/tede/handle/tede/731.
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Previous issue date: 2015-12-26The aim of this study was to compare the effects of laser acupuncture and electroacupuncture on postoperative pain and analgesic requirements in cats. Thirty cats undergoing ovariohysterectomy were sedated with IM ketamine (5mg/kg), midazolam (0.5mg/kg) and tramadol (2mg/kg). Prior to induction of general anesthesia, the subjects were randomly distributed into three groups of ten cats each: LA: bilateral stomach 36 and spleen 6 acupoints were stimulated with an infrared laser; EA: bilateral stomach 36 and spleen 6 acupoints were stimulated with an electrical stimulus; Control: no acupuncture was applied. Anesthesia was induced with IV propofol (4mg/kg) and maintained with isoflurane/O2. Postoperative analgesia was evaluated by a blinded assessor at 0.5, 1, 2, 4, 8, 12, 18, and 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Scale. Rescue analgesia was provided with IM tramadol (2mg/kg), and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg/kg IM, single dose) was administered. Data were analyzed using t-tests, the Mann-Whitney U test and Friedman test. P < 0.05 was considered significant. There were no significant differences among groups for demographic data or pain scores. Cats in the Control group received significantly more postoperative supplemental analgesia than the LA and EA groups (P = 0.026). In the contexts analyzed, both acupuncture techniques (LA and EA) reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy.
Objetivou-se comparar a aplicação do laser ao estímulo elétrico em pontos de acupuntura como adjuvante do controle da dor pós-operatória em gatas. Foram avaliadas 30 gatas, encaminhadas para ovariosalpingohisterectomia (OSH), que foram distribuídas em três grupos de dez animais cada: LA: aplicação de laser infravermelho nos acupontos estômago 36 (E36) e baço-pâncreas 6 (BP6), bilateralmente, durante 9 segundos em cada ponto, antes da indução anestésica; EA: aplicação de estímulo elétrico nos acupontos E36 e BP6, bilateralmente, durante 20 minutos, antes da indução anestésica; Controle: não foram feitos nenhum estímulo com técnicas de acupuntura. Todos os animais foram sedados com a associação de cetamina (5mg kg-1), midazolam (0,5mg kg-1) e tramadol (2mg kg-1), por via intramuscular. Quinze minutos após, foi iniciada a aplicação da acupuntura nos tratamentos LA e EA. A indução e manutenção anestésicas foram realizadas com propofol efeito dose-dependente e isofluorano, respectivamente. No período pós-operatório o grau de analgesia foi mensurado 0,5, 1, 2, 4, 8, 12, 18 e 24 horas após extubação traqueal utilizando-se a Escala Analógica Visual Interativa e Dinâmica e a Escala de Contagem Variável. O grau de sedação foi avaliado por sistema de escore. A estatística foi feita com análise de variância com aplicação do teste de Tukey (dados paramétricos) e teste de Kruskall-Wallis com pós-teste de Dunn (dados não paramétricos), ao nível de 5% de significância. As variáveis cardiorrespiratórias, os escores de dor e de sedação não diferiram entre os grupos. Todavia, a necessidade de analgesia de resgate no período pós-cirúrgico foi significativamente inferior nos grupos LA e EA em relação ao grupo controle (P=0,0026). A aplicação pré-operatória de laser ou estímulo elétrico em pontos de acupuntura reduz o requerimento de analgesia suplementar pós-operatória em gatas submetidas à OSH.
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Nicácio, Gabriel Montoro. "Toxina Botulínica Tipo A Intra-Articular como Adjuvante no Controle da Dor em Cães com Displasia Coxofemoral". Universidade do Oeste Paulista, 2015. http://bdtd.unoeste.br:8080/tede/handle/tede/735.
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Previous issue date: 2015-11-25This study aims to determine the efficacy of intra-articular (IA) administration of botulinum toxin type A (BoNT/A) in dogs with signs of chronic pain associated with hip dysplasia. In a double-blind design fourteen dogs were randomized and distributed into two groups: BoNT (n=7): IA injection with 25U (0,5 mL) of botulium toxin; Control (n=7): IA injection with saline solution (0.5 mL). All dogs received conventional treatment with oral and carprofen (2.2 mg/kg, every 12 h, 15 days), and chondroitin sulfate (750-1000 mg, every 12 h, 90 days). The clinical signs of HD were evaluated prior to treatment (baseline), 15, 30, 60, and 90 days after the IA injection by the veterinary using a score system and by the owners with a questionnaire about their dog s condition using the Canine Brief Pain Inventory (CBPI) and Helsinki Chronic Pain Index (HCPI). The data were analyzed using test unpaired-t, ANOVA, Tukey test (P < 0.05). There was no difference between groups in the scores measured by the veterinary and by the owners (CBPI and HCPI). In comparison over time lower scores were observed in both groups during 90 days from baseline in the researcher evaluation and in the HCPI. The same result was obtained by the CBPI evaluation to the control group whereas for the BoNT group the difference was only observed in the first 60 days after IA injection. Analgesic intervention was not necessary during the evaluation period. Both treatments reduced the clinical signs associated with hip dysplasia, however adjunctive administration of BoNT didn t potentialize the results.
Objetivou-se avaliar a administração intra-articular (IA) da toxina botulínica tipo A (BoNT/A) como adjuvante do controle da dor crônica em cães com displasia coxofemoral (DCF). Em delineamento duplo-cego, 14 cães foram distribuídos aleatoriamente em dois grupos: BoNT (n=7): administração IA de 25U (0,5 mL) de toxina botulínica; Controle (n=7): administração IA de 0,5 mL de solução salina. Para todos os animais foi prescrito tratamento convencional com carprofeno (15 dias) e sulfato de condroitina (90 dias). Os sinais clínicos da DCF foram avaliados, antes do tratamento (basal), 15, 30, 60 e 90 dias após a injeção IA, por sistema de escore pelo pesquisador e mediante questionários respondidos pelos proprietários dos cães, empregando-se o Breve Inventário de Dor Canina (BIDC) e o Indicador de Dor Crônica de Helsinque (IDCH). Intervenção analgésica foi permitida se o somatório dos escores do BIDC e/ou IDCH excedesse 50%. Os resultados foram analisados pelo teste t não-pareado, ANOVA, teste de Tukey (P < 0,05). Não houve diferença entre os grupos nos escores avaliados pelo médico veterinário ou pelos proprietários (BIDC e IDCH). Na comparação ao longo tempo, escores inferiores foram observados em ambos os grupos durante 90 dias em relação ao basal na avaliação do pesquisador e no IDCH. O mesmo resultado foi obtido na avaliação pelo BIDC para o grupo controle, enquanto no grupo BoNT a diferença só foi observada nos primeiros 60 dias após a injeção IA. Intervenção analgésica não foi necessária durante o período de avaliação. Ambos os tratamentos reduziram os sinais clínicos associados à DCF, porém a administração adjuvante de toxina botulínica não potencializou os resultados.
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Steffens, João Paulo. "O uso de dexametasona e etoricoxibe para a prevenção e controle da dor pós-operatória após cirurgia periodontal". UNIVERSIDADE ESTADUAL DE PONTA GROSSA, 2009. http://tede2.uepg.br/jspui/handle/prefix/1756.
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Previous issue date: 2009-12-11Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Several anti-inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. The purpose of this study was to evaluate the efficacy of etoricoxib and dexamethasone on pain prevention after open flap debridement surgery. For this prospective, double-masked, cross-over, placebo-controlled randomized clinical trial, open flap debridement surgeries were performed on 15 patients who presented chronic periodontitis after nonsurgical periodontal therapy at three sextants. Each patient was submitted to three surgical procedures with intervals of 30 days and received one of the premedication protocols one hour before surgery: G1- placebo; G2- 8 mg dexamethasone; G3- 90 mg etoricoxib. Pain intensity and discomfort were evaluated by visual analog scale (VAS), 101-point numerical rate scale (NRS-101) and a 4-point verbal rate scale (VRS-4) during 8 hours after surgery and three times a day on the 3 following days. Data were submitted to appropriate statistical analysis. The results demonstrated that G2 and G3 presented reduced postoperative pain intensity levels than G1. There were statistically significant differences at 4, 5, 6, 7 and 8 hour-period after surgery (Friedman test; p<0.05). Besides, rescue medication intake was significantly lower for G2 and G3 than for G1 (p<0.05). It was concluded that the adoption of a preemptive medication protocol using etoricoxib or dexamethasone may be considered effective on pain prevention after open flap debridement surgeries.
Diversas drogas anti-inflamatórias têm sido utilizadas para reduzir dor e desconforto após cirurgias periodontais. O objetivo deste estudo foi avaliar a eficácia do etoricoxibe e dexametasona na prevenção da dor após cirurgia a retalho para raspagem e alisamento radicular. Neste ensaio clínico prospectivo randomizado, cruzado, duplo-cego, placebo-controlado, foram realizadas cirurgias para raspagem e alisamento radicular em 15 pacientes que apresentassem periodontite crônica após terapia periodontal não cirúrgica, em pelo menos três sextantes. Cada paciente foi submetido aos três procedimentos cirúrgicos com intervalos de pelo menos 30 dias, recebendo um dos seguintes protocolos de medicação uma hora antes do procedimento: G1- placebo; G2- dexametasona 8 mg; G3- etoricoxibe 90 mg. A intensidade da dor e desconforto foi avaliada através de escala visual analógica (EVA), escala numérica de 101 pontos (NRS-101) e escala verbal de 4 pontos (VRS- 4) a cada hora durante 8 horas após cada cirurgia, e três vezes ao dia nos três dias seguintes. Os dados foram submetidos à análise estatística apropriada. Os resultados demonstraram que G2 e G3 apresentaram menores valores de intensidade de dor pós-operatória do que G1, havendo diferença estatisticamente significante pelo teste de Friedman (p<0,05) nos períodos de 4, 5, 6, 7 e 8 horas pós-cirurgia. Além disto, houve significativamente menos consumo de analgésicos de suporte em G2 e G3 que no G1 (p<0,05). Concluiu-se que a adoção de um protocolo de medicação pré-operatória com etoricoxibe ou dexametasona pode ser considerada uma abordagem eficaz na prevenção da dor após cirurgia a retalho para raspagem e alisamento radicular.
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Figueiredo, Roberta Cristina Campos. "Avaliação comparativa da ação da gabapentina ou amitriptilina sobre o controle dador neuropática de origem não-oncológica e sobre os níveis séricos de interleucina-6 (IL-6) e TNF-α em cães". Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-30102013-103431/.
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A utilização de adjuvantes como gabapentina e amitriptilina por via sistêmica é uma ótima opção no tratamento analgésico de síndromes dolorosas crônicas que culminam com hiperalgesia e alodinia, com baixa incidência de efeitos colaterais. Entretanto, os efeitos do emprego destes fármacos em cães ainda são pouco conhecidos, bem como sua real aplicação, pois faltam estudos clínicos nesta espécie. Portanto, este estudo teve o intuito de avaliar a ação analgésica da administração de isolada de gabapentina ou amitriptilina em cães portadores de dor crônica de qualquer etiologia que não oncollógica. Avaliou-se o efeito analgésico através da escala numérica verbal (ENV), questionário de qualidade de vida e testes para verificação de alodinia. Foram também avaliados os valores do hemograma completo, funções hepática e renal dos animais incluídos no estudo antes e após o tratamento, afim de que a segurança dos fármacos seja verificada.Foram dosados níveis séricos de TNF-α e IL-6 para comparação dos valores antes e após a terapia. Animais que necessitaram de resgate analgésico receberam dipirina 25 mg/kg. Foram utilizados 18 animais provenientes do Ambulatório de Dor e Cuidados Paliativos do Hospital Veterinário da Universidade de São Paulo. Estes animais foram distribuídos em 2grupos de forma aleatória, com 9 animais em cada grupo. Os animais participantes do presente estudo receberagabapentina na dose de 10 mg/kg a cada 12 horas, ou amitriptilina 1 mg/kga cada 24 horas pela via oral.Os retornos foram realizados semanalmente, avaliando-se valores da ENV, qualidade de vida e alodinia. Os resultados foram analisados estatisticamente pelo teste de Wilcoxon para dados não paramétricos. Com base nos resultados obtidos, pôde-se concluir que o uso isolado da gabapentina e da amitriptilina promovemelhora na qualidade de vida e redução dos escores na ENV em cães portadores de dor crônica neuropática, apesar de demonstrarem resultados ainda melhores como parte de um protocolo de analgesiamultimodal. A amitriptilina demonstrou-se superior, pois os componentes de seu grupo não necessitaram de resgate e obtiveram maior redução de escores de dor na ENV e alodinia e melhores índices de qualidade de vida. Os animais pertencentes ao grupo da gabapentina não apresentaram melhora significativa nos parâmetros observados. Não foram observados efeitos adversos relacionados durante o período do estudo.The use of adjuvants such as amitriptyline and gabapentin systemically is a great option in analgesic treatment of chronic pain syndromes that culminate with hyperalgesia and allodynia, with a low incidence of side effects. However, the employment effects of these drugs in dogs are still poorly understood, and their actual implementation, because clinical trials are lacking in this species. Therefore, this study aimed to evaluate the analgesic effect of single administration of gabapentin or amitriptyline in dogs with chronic pain of any etiology but cancer. The analgesic effect was evaluadted by the verbal numeric scale (VNS), quality of life questionnaire and tests to check allodynia. Was also evaluated the values of blood count, liver and renal function of animals included in the study before and after treatment, in order to verify the safety of the drugs. Serum levels of TNF-α and IL-6 were measured for comparison of values before and after therapy.Animalswho required analgesic rescued recevied 25 mg/kg of dipyrone or it combined with 2 mg/kg of tramadol. Eighteen animals provenient from the Clinic of Pain and Palliative Care of the Veterinary Hospital of the University of São Paulo were used for this study. There animals were radomly divided into two groups with nine animals per group.The animals in the present study received orally 10 mg/kg of gabapentin every 12 hours. The animals retornedeveryweek in order to evaluate the VNS values ,quality of life and allodynia. The results were statistically analyzed by the Wilcoxon test for nonparametric data and ANOVA for parametric data. In the VNS avaliation, no statistical significance between times or between groups were observed. There was a significant decrease in values of quality of life in two groups, between moment one and four, with p 0.05, but not between the two groups.Regarding the assessment of allodynia, only the amitriptyline group showed statistical significance, with p 0.05.Significance was not observed when comparing the two groups with regard to allodynia. There were no significant changes in parameters related to blood count, renal and hepatic function when compared to the data obtained before and after treatment with the study drugs.Based on these results, we concluded that adjuvant drugs used on this study promoted good analgesia for dogs with chronic non-oncologic pain, amitriptyline at a dose of 1 mg / kg demonstrated analgesic efficacy slightly superior to gabapentin at a dose of 10 mg / kg. No adverse effects related to physiological parameters were observed during the study period.
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Vilhegas, Sérgio. "TOXINA BOTULÍNICA TIPO A COMO ADJUVANTE NO CONTROLE DA DOR PÓS-OPERATÓRIA EM CADELAS SUBMETIDAS À MASTECTOMIA". Universidade do Oeste Paulista, 2013. http://bdtd.unoeste.br:8080/tede/handle/tede/283.
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Previous issue date: 2013-09-23The aim of this study was to evaluate the analgesic effects of botulinum toxin as an adjunct in the control of postoperative pain in dogs. In a blinded study, sixteen dogs undergoing mastectomy were randomly assigned to two groups of 08 animals each and received 7U kg-1 of botulinum toxin diluted in 10mL of saline and administered 1mL in each breast, subcutaneously (TXB) or 1mL of saline administered in each breast (Control), subcutaneously. After twenty four hours, 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 (4 to 5mg kg-1) and maintained with isoflurane. 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, oxicapnografy 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 Visual Analog Scale (VAS) and Glasgow Modified Scale (GMS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of VAS and/or 30% of GMS during the postoperative period. The pain scores were lower in TXB group than in Control group from 8 to 60 hours and from 12 to 60 hours post-extubation, according to VAS and GMS scales, respectively. Postoperative rescue analgesia was lower in the TXB group (2 of 8 dogs), when compared with Control group (7 of 8 dogs). Cardiopulmonary established was detected in both treatment groups. Preemptive botulinum toxin administration is a satisfactory alternative to post-operative management in dogs undergoing mastectomy.
Este estudo teve como objetivo avaliar a administração da toxina botulínica como adjuvante do controle da dor pós-operatória de cães. Em delineamento cego, dezesseis cadelas, encaminhadas para mastectomia radical foram distribuídas aleatoriamente em dois tratamentos: TXB (n=8) administração de 7U kg-1 de toxina botulínica, diluída em 10 mL de solução salina, sendo administrado 1mL em cada mama, por via subcutânea (SC); Controle (n=8) administração de 10 mL de solução salina (1mL em cada mama, SC). Vinte e quatro horas após, os animais foram encaminhados para cirurgia, sendo tranquilizados com acepromazina (0,03mg kg-1) associada à morfina (0,3mg kg-1), por via intramuscular (IM). Transcorridos vinte minutos, iniciou-se a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1) que foi mantida durante toda a cirurgia. A indução anestésica foi realizada com propofol (4-5mg kg-1, IV), seguindo-se a manutenção da anestesia com isofluorano. Parâmetros avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia e concentração final expirada de isofluorano. No pós-operatório o grau de analgesia foi mensurado durante 72 horas após a extubação traqueal, utilizando-se a Escala Analógica Visual (EAV) e Escala de Glasgow Modificada (EGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% da EAV e/ou 33% da EGM. Os escores de dor foram inferiores no tratamento TXB de 8 a 60 horas na EAV e de 12 a 60 horas na EGM. A necessidade de suplementação analgésica foi inferior no gruo TXB (2 de 8 animais) em relação ao grupo Controle (7 de 8 animais). Estabilidade cardiorrespiratória foi observada em ambos os tratamentos. A administração preemptiva de toxina botulínica representa uma alternativa viável para o controle da dor pós-mastectomia em cadelas.
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Rodrigues, Denise de Fátima [UNESP]. "Efeito da arnica 6D e 30D administradas por via transmucosa oral e subcutânea no controle da dor pós-operatória de gatas submetidas à ovariossalpingohisterectomia". Universidade Estadual Paulista (UNESP), 2011. http://hdl.handle.net/11449/101081.
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Avaliou-se o efeito analgésico de Arnica em comparação à utilização de cetoprofeno, no pós operatório de 50 gatas submetidas à ovariossalpingohisterectomia (OSH). Para tanto, as gatas foram divididas em cinco grupos (n=10) e de forma aleatória os animais foram tratados com 1 ml de Arnica 30DH SC (GA30SC); Arnica 30 DH VO (VO) (GA30VO); Arnica 6 DH VO (GA6VO); 2mg/kg de cetoprofeno SC (GC) na primeira aplicação, e 1mg/Kg nas restantes ou 0,1mg/kg de morfina SC (GM). Após 30 minutos realizou-se a OSH e os animais foram avaliados quanto à sedação e dor pós-operatória, por meio de EAV, ECV e hiperalgesia, pelo limiar mecânico nociceptivo por meio dos monofilamentos de Von Frey. Quando o escore da ECV e EAVID atingiram 33% do valor máximo foi realizado o resgate analgésico administrando-se 0,3 mg/kg de morfina IM. Além das escalas anteriormente citadas também foi observado a ocorrência de emese, defecação, micção, peso e cicatrização. Com exceção dos animais tratados com morfina, não houve incidência de vômito. Não houve diferença significativa entre os grupos na defecação, micção, peso e cicatrização. A hiperalgesia foi observada apenas nos momentos em que a EAVID e ECV ultrapassaram 33%, isto é nos momentos em que foi realizado o resgate analgésico. O cetoprofeno e a morfina foram mais eficazes que a Arnica, não houve diferença entre as dinamizações 6DH e 30DH VO, nem entre as vias SC e oral de administração da Arnica em gatas submetidas à OSH
The analgesic effect of Arnica was compared to ketoprofen in 50 cats undergoing ovariosalpingohysterectomy (OSH). Cats were randomly divided into five groups of same number (n=10). The animals were treated with 1 ml of Arnica montana 30DH subcutaneously (SC) (GA30SC); Arnica montana 30 DH orally (GA30VO); Arnica montana 6 DH orally (GA6VO); 2 mg/kg of ketoprofen SC (GC) or 0.1 mg/kg of morphine SC (GM). Surgery was performed 30 minutes after treatments and the animals were evaluated for sedation and postoperative pain through visual analogue scale (VAS), variable count scale (VCS) and hyperalgesia, measuring the mechanical nociceptive threshold by von Frey monofilaments. When VAS and VCS score reached 33% of the of the maximum, analgesic rescue was performed by administering 0.3 mg/kg of morphine intramuscularly. Occurrence of vomiting, stools, urine output, weight and healing was evaluated in addition to the aforementioned scales. Except for the animals treated with morphine, there was no vomiting. There was no significant difference between groups in the stools, urine output, weight and healing. The hyperalgesia was observed only when the VCS exceeded 33% of the total score, when animals received rescue analgesia, but there were no differences between groups. Ketoprofen and morphine were more effective than Arnica montana for postoperative analgesia in cats undergoing ovariohysterectomy. There was no difference between oral Arnica montana at 6DH and 30DH or subcutaneous and oral administration of Arnica montana in cats undergoing ovariohysterectomy
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PEREIRA, Nayara Caroline. "O efeito da artemisinina no controle da dor nociceptiva, inflamatória aguda e neuropática em ratos". Universidade Federal de Alfenas, 2018. https://bdtd.unifal-mg.edu.br:8443/handle/tede/1146.
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Introdução: A Artemisinina, extraída das folhas de Artemisia Annua, é um tipo de
lactona sesquiterpênica e possui uma variedade de efeitos farmacológicos
importantes e aplicações potenciais, incluindo seu uso contra a malária, tumores e
inflamação, bem como sua capacidade de melhorar a função imunológica. Essas
aplicações sugerem que pode ter um papel no controle da dor. Assim, o objetivo do
presente estudo foi avaliar o efeito da Artemisinina no controle da dor nociceptiva,
inflamatória aguda e neuropática em ratos. Métodos: Foram utilizados ratos Wistar
machos, divididos em três grupos: (1) dor nociceptiva, avaliados no teste de latência
de retirada da cauda; (2) dor inflamatória, induzida por Adjuvante Completo de Freund
(CFA) e (3) dor neuropática, submetidos ao modelo de constrição crônica do nervo
isquiático (CCI). Os animais tiverem seus limiares basais avaliados, e após indução
da dor por CFA e CCI houve novamente avaliação de seus limiares e ainda nos
tempos 0, 1, 3, 6 e 24 h após a administração oral única de solução Salina (controle)
ou Artemisinina em três doses: 0,03mg/kg, 0,3mg/kg e 3mg/kg. Ainda utilizamos o
teste de campo aberto para excluir possíveis efeitos motores. Os resultados foram
analisados por two-way ANOVA seguido pelo pós-teste de Bonferroni. Resultados:
No teste de latência de retirada da cauda, os animais tratados com Artemisinina
demonstraram um aumento no tempo de latência após 3 horas ao tratamento que se
manteve por 24 horas, nas três doses administradas, quando comparado ao grupo
controle. No modelo de dor inflamatória, no teste de Von Frey digital, os animais
tratados com Artemisinina apresentaram aumento no limiar de pressão logo após
administração (T0) que se manteve por 24 horas, nas três doses administradas,
quando comparados ao controle. No modelo de dor neuropática, no teste de Von Frey
digital, os animais tratados com Artemisinina apresentaram aumento no limiar após 1
hora do tratamento que se manteve por 24 horas, nas três doses administradas,
quando comparados ao controle. Não houve diferença no teste do campo aberto.
Conclusão: Os resultados demonstram que a Artemisinina é capaz de aliviar os
comportamentos da dor nos ratos submetidos aos modelos de dor nociceptiva,
inflamatória aguda e neuropática.Introduction: Artemisinin, extracted from the leaves of Artemisia Annua, is a type of sesquiterpene lactone and has a variety of important pharmacological effects and potential applications, including its use against malaria, tumors and inflammation, as well as its ability to improve immune function. These applications suggest that it may play a role in pain control. Thus, the objective of the present study was to evaluate the effect of Artemisinin on the control of nociceptive, acute and neuropathic inflammatory pain in rats. Methods: Male Wistar rats were divided into three groups: (1) nociceptive pain, evaluated in the tail withdrawal test; (2) inflammatory pain induced by Freund's Complete Adjuvant (CFA) and (3) neuropathic pain, submitted to the chronic constriction of the sciatic nerve (CCI) model. The animals had their baseline thresholds evaluated, and after induction of pain by CFA and CCI, their thresholds were again evaluated, and at 0, 1, 3, 6 and 24 hours after oral administration of saline (control) or Artemisinin in three doses: 0.03mg / kg, 0.3mg / kg and 3mg / kg. We still use the open field test to exclude possible motor effects. The results were analyzed by two-way ANOVA followed by the Bonferroni post-test. Results: In the nociceptive pain model in the tail-removal test, animals treated with Artemisinin demonstrated a reduction in latency time at 3 hours, which was maintained for 24 hours at three doses, when compared to the control group. In the model of inflammatory pain, in the digital Von Frey test, animals treated with Artemisinin showed an increase in the pressure threshold after administration (T0), which was maintained for 24 hours in the three doses when compared to the control. In the model of neuropathic pain, in the digital Von Frey test, the animals treated with Artemisinin presented increase in the threshold in the after 1 hour that was maintained for 24 hours in the three doses, when compared to the control. There was no difference in the open field test. Conclusion: The results demonstrate that Artemisinin is capable of alleviating pain behaviors in rats submitted to nociceptive, acute inflammatory and neuropathic pain models.
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
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Castilho, Marcelo de Paula Mendes. "O controle da dor pós-operatória em um hospital terciário". Botucatu, 2018. http://hdl.handle.net/11449/157490.
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Orientador: Fernanda Bono FukushimaResumo: Introdução: A dor aguda é um fenômeno universal. O tratamento desse evento, entretanto, ainda é visto através de diversos vieses culturais, sociais e econômicos. Em situação de dor aguda pós-operatória estima-se que 40% dos pacientes apresentam controle inadequado da dor (intensidade moderada a intensa). O presente trabalho visa analisar a percepção de pacientes recém operados quanto à analgesia pós-operatória que receberam em um hospital escola terciário de natureza pública, bem como descrever as medidas prescritas e realizadas para analgesia pós-operatória de acordo com seu registro em prontuário. Método: Estudo transversal, descritivo, realizado em pacientes internados, submetidos a procedimentos cirúrgicos cardiovasculares, gastrointestinais, ginecológicos, hemodinâmicos, mastológicos, neurológicos, ortopédicos, torácicos, urológicos ou vasculares no período de junho a dezembro de 2017 no Hospital das Clínicas da Faculdade de Medicina da UNESP, em Botucatu. Os pacientes foram entrevistados no 2º dia pós-operatório (2º PO) sobre sua experiência no 1º dia pós-operatório (1º PO) quanto ao controle da dor. Através de entrevista semiestruturada o paciente foi inquerido quanto a intensidade da sua dor, a satisfação quanto a analgesia recebida, e sua impressão geral do atendimento prestado pela equipe de saúde assistente. Foi realizada revisão dos prontuários e registrados dados quanto a frequência do registro de avaliação da dor, analgesia prescrita e fornecida, bem como sobre ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Justifications and Objectives: Acute pain is a universal phenomenon. However, the treatment of this event still has a diversity of cultural, social and economical biases. It is estimated that 40% of patients present inadequate management of pain (moderate to severe intensity) in a situation of acute postoperative pain. The aim of the present study is to analyze the perception of patients, who recently operated, regarding postoperative analgesia in a public tertiary hospital school. In addition, to describe the prescribed and performed postoperative analgesia according to registration in medical records. Methods: A cross-sectional, descriptive study was performed in hospitalized patients submitted to cardiovascular, gastrointestinal, gynecological, hemodynamic, mastological, neurological, orthopedic, thoracic, urological or vascular surgical procedures from June 2017 to December 2017 at Hospital das Clínicas, Faculdade de Medicina da UNESP, Botucatu, Brazil. Patients were interviewed on the second day of the postoperative period about their experience on the first day postoperative as to their pain control. Through a semi-structured interview, patients were asked about the intensity of pain, satisfaction as to the analgesia, and general impression of the process. Medical records were reviewed, and data were recorded as to the frequency of recorded pain, analgesia prescription and its administration, and side effects as well. Results: 159 patients met the criteria established t... (Complete abstract click electronic access below)
Mestre
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Rodrigues, Denise de Fátima. "Efeito da arnica 6D e 30D administradas por via transmucosa oral e subcutânea no controle da dor pós-operatória de gatas submetidas à ovariossalpingohisterectomia /". Botucatu : [s.n.], 2011. http://hdl.handle.net/11449/101081.
Texto completoResumen
Orientador: Stelio Pacca Loureiro LunaBanca: Antonio José de A. Aguiar
Banca: Adriano B. Carregaro
Banca:Renata Navarro Cassu
Resumo: Avaliou-se o efeito analgésico de Arnica em comparação à utilização de cetoprofeno, no pós operatório de 50 gatas submetidas à ovariossalpingohisterectomia (OSH). Para tanto, as gatas foram divididas em cinco grupos (n=10) e de forma aleatória os animais foram tratados com 1 ml de Arnica 30DH SC (GA30SC); Arnica 30 DH VO (VO) (GA30VO); Arnica 6 DH VO (GA6VO); 2mg/kg de cetoprofeno SC (GC) na primeira aplicação, e 1mg/Kg nas restantes ou 0,1mg/kg de morfina SC (GM). Após 30 minutos realizou-se a OSH e os animais foram avaliados quanto à sedação e dor pós-operatória, por meio de EAV, ECV e hiperalgesia, pelo limiar mecânico nociceptivo por meio dos monofilamentos de Von Frey. Quando o escore da ECV e EAVID atingiram 33% do valor máximo foi realizado o resgate analgésico administrando-se 0,3 mg/kg de morfina IM. Além das escalas anteriormente citadas também foi observado a ocorrência de emese, defecação, micção, peso e cicatrização. Com exceção dos animais tratados com morfina, não houve incidência de vômito. Não houve diferença significativa entre os grupos na defecação, micção, peso e cicatrização. A hiperalgesia foi observada apenas nos momentos em que a EAVID e ECV ultrapassaram 33%, isto é nos momentos em que foi realizado o resgate analgésico. O cetoprofeno e a morfina foram mais eficazes que a Arnica, não houve diferença entre as dinamizações 6DH e 30DH VO, nem entre as vias SC e oral de administração da Arnica em gatas submetidas à OSH
Abstract: The analgesic effect of Arnica was compared to ketoprofen in 50 cats undergoing ovariosalpingohysterectomy (OSH). Cats were randomly divided into five groups of same number (n=10). The animals were treated with 1 ml of Arnica montana 30DH subcutaneously (SC) (GA30SC); Arnica montana 30 DH orally (GA30VO); Arnica montana 6 DH orally (GA6VO); 2 mg/kg of ketoprofen SC (GC) or 0.1 mg/kg of morphine SC (GM). Surgery was performed 30 minutes after treatments and the animals were evaluated for sedation and postoperative pain through visual analogue scale (VAS), variable count scale (VCS) and hyperalgesia, measuring the mechanical nociceptive threshold by von Frey monofilaments. When VAS and VCS score reached 33% of the of the maximum, analgesic rescue was performed by administering 0.3 mg/kg of morphine intramuscularly. Occurrence of vomiting, stools, urine output, weight and healing was evaluated in addition to the aforementioned scales. Except for the animals treated with morphine, there was no vomiting. There was no significant difference between groups in the stools, urine output, weight and healing. The hyperalgesia was observed only when the VCS exceeded 33% of the total score, when animals received rescue analgesia, but there were no differences between groups. Ketoprofen and morphine were more effective than Arnica montana for postoperative analgesia in cats undergoing ovariohysterectomy. There was no difference between oral Arnica montana at 6DH and 30DH or subcutaneous and oral administration of Arnica montana in cats undergoing ovariohysterectomy
Doutor
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Silva, Magda Aparecida dos Santos. "Efeitos da intervenção treinamento, avaliação e registro sistematizado no controle da dor pós-operatória de cirurgia cardíaca". Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-17052007-111100/.
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Trata-se de um ensaio clínico com três Grupos. Avaliaram-se os efeitos da intervenção \"Treinamento, Avaliação e Registro Sistematizado de Dor\" sobre a intensidade da dor, o consumo suplementar de morfina, o tratamento de efeitos colaterais e a satisfação com a analgesia dos doentes, no pós-operatório de cirurgia cardíaca. Foram estudados 182 doentes, no Grupo I (GI, N=55), Grupo II (GII, N=66) e Grupo III (GIII, N=61). Todos receberam a mesma orientação pré-operatória e submeteram-se ao mesmo protocolo medicamentoso para o controle de dor e dos efeitos colaterais. No GI a equipe de enfermagem não recebeu Treinamento e realizou a avaliação da dor conforme rotina da instituição. Nos GII e GIII toda a equipe de enfermagem participou do Curso de Capacitação Sobre a Dor e Seu Controle (Treinamento). No GII a equipe de enfermagem utilizou a Ficha Sistematizada sobre Dor e seu Controle, a cada duas horas. No GIII a equipe de enfermagem não utilizou esta Ficha. Os doentes dos três Grupos também foram avaliados pela pesquisadora nas primeiras 30 horas, a cada 6 horas (6 Momentos). Os resultados foram analisados pelos testes de Kruskal-Wallis, Dunn, Friedman, Qui-quadrado e Verossimilhança. O nível de significância adotado foi de 5%. Os Grupos foram semelhantes quanto à idade, sexo, escolaridade, tipo de cirurgia, tipo de dreno e estado físico. A dor ao repouso e à tosse foi menos intensa no GII. Ao repouso observou-se diferença no Momento 2 (p=0,012) e à tosse, nos Momentos 2, 3, 4 e 6 (p=0,021, p=0,005, p=0,048 e p=0,001, respectivamente). Na dor à inspiração profunda não houve diferença intergrupos. No GII observou-se maior uso de morfina suplementar (p=0,002), maior número de doentes recebendo morfina (p=0,002) e maior média na relação dose de morfina/doente (p=0,022). O GI foi o que menos recebeu antiemético (p=0,019, Momento 2) mas teve a maior ocorrência de náusea e vômito (p=0,032, Momento 6). Prurido ocorreu somente uma vez e não houve depressão respiratória. A satisfação com a analgesia foi mais elevada no GII nos Momentos 2 e 3 (p=0,001 e p=0,012). O Treinamento associado à Ficha Sistematizada sobre a Dor e seu Controle incitou os enfermeiros a intervirem mais vezes para o ajuste da analgesia, melhorou o controle da dor e a satisfação dos doentes com a analgesia. Mostrou-se a melhor opção para o controle da dor no pós-operatório de cirurgia cardíacaThis paper reports on a clinical trial with three Groups. The effects of the intervention \"Training, Assessment and Registration of Pain\" on pain intensity, supplementary consumption of morphine, treatment of side effects, and satisfaction with analgesia among patients in post-operative cardiac surgery. The sample were studied 182 patients, in Group I (GI, N=55), Group II (GII, N=66) and Group III (GIII, N=61). All received the same pre-operative guidelines and submitted themselves to the same medication protocol for the control of pain and its side effects. In GI, the nursing team did not receive the Training, and carried out the pain assessment according to the routine practice of the institution. In GII and GIII, all the nursing team took part in the Curso de Capacitação Sobre a Dor e Seu Controle (Training Course on Pain and its Control). In GII the nursing team used the Ficha Sistematizada sobre Dor e seu Controle (Systematized Record of Pain and its Control) every two hours. In GIII the nursing team did not use this Record. The patients in the three Groups were assessed by the researcher every 6 hours, for the first 30 hours (6 separate moments). The results were analyzed by the Kruskal-Wallis, Dunn, Friedman, Qui-quadrado and Verossimilhança tests. The level of significance adopted was 5%. The Groups were similar, in terms of age, sex, level of education, type of surgery, type of drainage and physical state. The pain in rest and when coughing were less intense in GII. For pain in rest, a difference was observed in Moment 2 (p=0.012) and when coughing, in Moments 2, 3, 4 and 6 (p=0.021, p=0.005, p=0.048 and p=0.001, respectively). For pain on deep inspiration, there was no difference between the groups. In GII, greater use of supplementary morphine was observed (p=0.002), with a higher number of patients receiving morphine (p=0.002), and a higher average ratio of morphine dose to patient (p=0.022). GI was the group which received the least antiemetic (p=0.019, Moment 2) but had the highest occurrence of nausea and vomiting (p=0,032, Moment 6). Pruritis occurred only once, and there was no respiratory depression. Satisfaction with the analgesia was higher in GII in Moments 2 and 3 (p=0.001 and p=0.012). The Training, together with the Systematized Record of Pain and its Control led the nurses to intervene more often in adjusting the analgesia, which improved the pain control and the satisfaction of the patients with the analgesia. This proved to be the best option for the control of post-operative pain following cardiac surgery
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Pereira, Daniele Amaro. "Uso da morfina, xilazina e meloxicam para o controle da dor pós-operatória em cadelas submetidas à ovariosalpingohisterectomia /". Jaboticabal : [s.n.], 2007. http://hdl.handle.net/11449/89018.
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Orientador: José Antônio MarquesBanca: Newton Nunes
Banca: Angelica Trazzi Bento de Moraes
Resumo: Foram avaliados os efeitos comportamentais, fisiológicos, analgésicos e cardiorrespiratórios no pós-operatório de cadelas submetidas à ovariosalpingohisterectomia. Os animais foram divididos aleatória e eqüitativamente em quatro grupos com cinco animais cada: grupo morfina (GM) administrada na dose de 0,1 mg/kg por via epidural; grupo xilazina (GX) administrada na dose de 0,2 mg/kg por via epidural; grupo meloxicam (GME) administrado na dose de 0,2 mg/kg por via subcutânea e grupo controle (GC) administrada solução de cloreto de sódio a 0,9% via epidural, sendo o volume final ajustado para todos os grupos na dose de 0,3ml/kg. Objetivou-se avaliar o bem-estar animal no pós-operatório, o tempo e duração da analgesia das substâncias empregadas e a quantificação dos níveis de cortisol plasmático, comparando-se as quatro técnicas de tratamento. Antes da administração dos fármacos mensuraram-se os parâmetros clínicos e o cortisol plasmático. As mensurações ocorreram de 20 em 20 minutos até as duas horas após a epidural. A partir deste momento houve mensurações as seis, doze, e vinte e quatro horas. Houve uma redução significativa da freqüência cardíaca em 60% dos animais do grupo xilazina após duas horas da administração epidural da substância. Em todos os grupos houve uma diminuição da temperatura retal após M2. Os níveis de cortisol apresentaram valores inferiores no GM quando comparado ao GX após o tratamento epidural. No grupo morfina e xilazina, respectivamente, 20% dos animais apresentaram vômito e alterações comportamentais como recusa da alimentação, alterações na postura e alterações relacionadas ao meio. A perda dos reflexos dos membros pélvicos foi observada em 60% dos animais do grupo xilazina, uma hora após a epidural. A morfina por via epidural provocou prurido em 70% dos animais...(Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The behavioral, physiological, analgesic and cardiorrespiratory effects at the postoperative bitches submitted to ovariosalpingohysterectomy. The animals were devided both random and equitatively in 4 groups (5 animal in each group: the morphine group, named GM, administered on the dose of 0.1 mg/kg via epidural; group xylazine, name GX administered on the dose of 0.2 mg/kg also via epidural; group meloxican, named GME, administered on the dose of 0.2 mg/kg via subcutaneous and group GC, administered chlorine sodium at 0,9% via epidural. The final volume was adjusted for all the groups on the basis 0.3 ml/kg. The main focus was to evaluate the post operative animal welfare conditions, the time involved and the duration of the analgesia into the drugs that were employed, as well as the quantification of the plasmatic cortisol levels, in order to have compared the four treatments techniques. Before the suplying of the drugs, both clinic parameters and and the plasmatic cortisol were evaluated. The measurements occurred at intervals of 20 minutes until 2 hours later after the epidural. As of this moment, there were measurements at 6. 12 and 24 hours. There was a significant reduction in the cardiac frequency in 60% of the surveyed in the xylazine group after two hours of epidural administration of the drug. All the groups presented a decrease in the retal temperature after M2. The levels of cortisol presented inferior values at GM if compared to the GX after the epidural treatment. At both Morphine and xylazine groups, respectively, 20 of the animals vomitted, with behavioral alterations such as feeding refusal, posture alterations and posture regarding the environment, as well...(Complete abstract, access undermentioned eletronic address)
Mestre
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Cunha, Hugo Santos. "Ropivacaína a 0,75% versus lidocaína 2% com vasoconstritor no controle da dor associada à remoção dos terceiros molares inferiores inclusos : um ensaio clínico duplo-cego randomizado". reponame:Repositório Institucional da UnB, 2017. http://repositorio.unb.br/handle/10482/25241.
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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2017.Submitted by Raquel Almeida (raquel.df13@gmail.com) on 2017-11-13T20:45:33Z No. of bitstreams: 1 2017_HugoSantosCunha.pdf: 9129219 bytes, checksum: 5e76db854090d77596e00243b0eebc90 (MD5)
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Este estudo clínico randomizado duplo cego teve por objetivos avaliar a eficácia clínica e as variações hemodinâmicas geradas pelo anestésico local ropivacaína a 0,75% em cirurgias de terceiros molares inclusos em comparação à lidocaína 2% com vasoconstritor. Para isso foram selecionados 32 pacientes saudáveis que necessitaram de extração dos terceiros molares inferiores inclusos apresentando as mesmas condições clínicas definidas por meio de análise radiográfica. Os participantes foram randomicamente alocados em dois grupos de acordo com a droga a ser empregada: lidocaína 2% com epinefrina 1:100.00 no primeiro procedimento, seguida de ropivacaína a 0,75% na segunda intervenção (grupo 1 – Lidocaína), e ropivacaína a 0,75% e lidocaína 2% com epinefrina 1:100.00 no primeiro e segundos procedimentos, respectivamente (grupo 2 - Ropivacaína). Os dentes foram extraídos por um mesmo cirurgião realizando a extração de um lado por vez, com pelo menos 3 semanas entre os procedimentos. O tempo de procedimento foi registrado utilizando-se um crônometro bem como as variáveis hemodinâmicas por meio de pressão arterial, saturação de oxigênio e pulso. Ansiedade, dor, necessidades de anti-inflamatários, foram avaliados por meio de questionário e escala visual analógica. Para a análise dos dados, foram utilizados a análise descritiva com as freqüências ou médias com desvios padrão (DP), o teste t pareado, o teste McNemar e a Análise de variância (ANOVA) forma utilizados para comparar os grupos. O nível de significância foi estabelecido em 0,05 e todos os dados foram analisados usando Stata versão 13.0 (StataCorp LLC, Texas, EUA). A amostra foi composta por 38,7% de homens e 61,3% de mulheres com média de idade de 19,41 anos (± 6). Os dois grupos não diferiram em relação a ansiedade (p= 0,712), bem como em relação as análise hemodinâmicas (p>0,05). No que se refere à dor, o G2 reportou menos dor no pós-operatório que G1 (p= 0,001), entretanto essa diferença não foi encontrada por meio da análise das escalas quantitativa e qualitativa com p= 0,054 e p= 0,361, respectivamente. Por fim os participantes do G2 fizeram menos uso de antiinflamatório em relação a G1 (p= 0,001). Concluímos que a ropivacaína a 0,75% em sua fórmula pura gerou mais conforto ao paciente no pós-operatório e por conseguinte menor utilização de anti-inflamátorio. As condições hemodinâmicas obtidas com a ropivacaína foram comparáveis à droga padrão.
This double-blind randomized clinical study aimed to evaluate the clinical efficiency and hemodynamic variations generated by ropivacaine local anesthetic at 0.75% in the surgery of included third molars compared to lidocaine 2% with vasoconstrictor. For this, 32 healthy patients were selected who required extraction of included lower third molars, presenting the same clinical conditions defined by means of radiographic analysis. Participants were randomly assigned to two groups according to the drug to be used: lidocaine 2% with epinephrine 1: 100.00 in the first procedure, followed by 0.75% ropivacaine in the second intervention (group 1 - Lidocaine), and ropivacaine a 0.75% and lidocaine 2% with epinephrine 1: 100.00 in the first and second procedures, respectively (group 2 - Ropivacaine). The teeth were extracted by the same surgeon performing the extraction of one side at a time, with at least 3 weeks between the procedures. The procedure time was recorded using a chronometer as well as the hemodynamic variables through blood pressure, oxygen saturation and pulse measurement. Anxiety, pain, and anti-inflammatory needs were assessed using a questionnaire and visual analog scale. For data analysis, descriptive analysis was performed using frequencies or means with standard deviations (SD), the paired t test, the McNemar test and the analysis of variance (ANOVA) were applied for groups comparison. The level of significance was 0.05 and all data were analyzed using Stata version 13.0 (StataCorp LLC, Texas, USA). The sample consisted of 38.7% of males and 61.3% of females with a mean age of 19.41 years (± 6). The two groups did not differ in relation to anxiety (p = 0.712), as well as in hemodynamic analyzes (p> 0.05). Regarding pain, G2 reported less postoperative pain than G1 (p = 0.001); however, this difference was not found by analyzing the quantitative and qualitative scales with p = 0.054 and p = 0.361, respectively. Finally, G2 participants required less anti-inflammatory use compared to G1 (p = 0.001). We conclude that ropivacaine 0.75% in its pure formula provided more comfort to the patient in the postoperative period and, consequentely, less use of anti-inflammatory. The hemodynamic conditions obtained by ropovacaine were comparable to the standard drug.
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Pereira, Daniele Amaro [UNESP]. "Uso da morfina, xilazina e meloxicam para o controle da dor pós-operatória em cadelas submetidas à ovariosalpingohisterectomia". Universidade Estadual Paulista (UNESP), 2007. http://hdl.handle.net/11449/89018.
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pereira_da_me_jabo.pdf: 453195 bytes, checksum: 4f8721c920686b4fa354356b0a7f34c5 (MD5)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Foram avaliados os efeitos comportamentais, fisiológicos, analgésicos e cardiorrespiratórios no pós-operatório de cadelas submetidas à ovariosalpingohisterectomia. Os animais foram divididos aleatória e eqüitativamente em quatro grupos com cinco animais cada: grupo morfina (GM) administrada na dose de 0,1 mg/kg por via epidural; grupo xilazina (GX) administrada na dose de 0,2 mg/kg por via epidural; grupo meloxicam (GME) administrado na dose de 0,2 mg/kg por via subcutânea e grupo controle (GC) administrada solução de cloreto de sódio a 0,9% via epidural, sendo o volume final ajustado para todos os grupos na dose de 0,3ml/kg. Objetivou-se avaliar o bem-estar animal no pós-operatório, o tempo e duração da analgesia das substâncias empregadas e a quantificação dos níveis de cortisol plasmático, comparando-se as quatro técnicas de tratamento. Antes da administração dos fármacos mensuraram-se os parâmetros clínicos e o cortisol plasmático. As mensurações ocorreram de 20 em 20 minutos até as duas horas após a epidural. A partir deste momento houve mensurações as seis, doze, e vinte e quatro horas. Houve uma redução significativa da freqüência cardíaca em 60% dos animais do grupo xilazina após duas horas da administração epidural da substância. Em todos os grupos houve uma diminuição da temperatura retal após M2. Os níveis de cortisol apresentaram valores inferiores no GM quando comparado ao GX após o tratamento epidural. No grupo morfina e xilazina, respectivamente, 20% dos animais apresentaram vômito e alterações comportamentais como recusa da alimentação, alterações na postura e alterações relacionadas ao meio. A perda dos reflexos dos membros pélvicos foi observada em 60% dos animais do grupo xilazina, uma hora após a epidural. A morfina por via epidural provocou prurido em 70% dos animais...
The behavioral, physiological, analgesic and cardiorrespiratory effects at the postoperative bitches submitted to ovariosalpingohysterectomy. The animals were devided both random and equitatively in 4 groups (5 animal in each group: the morphine group, named GM, administered on the dose of 0.1 mg/kg via epidural; group xylazine, name GX administered on the dose of 0.2 mg/kg also via epidural; group meloxican, named GME, administered on the dose of 0.2 mg/kg via subcutaneous and group GC, administered chlorine sodium at 0,9% via epidural. The final volume was adjusted for all the groups on the basis 0.3 ml/kg. The main focus was to evaluate the post operative animal welfare conditions, the time involved and the duration of the analgesia into the drugs that were employed, as well as the quantification of the plasmatic cortisol levels, in order to have compared the four treatments techniques. Before the suplying of the drugs, both clinic parameters and and the plasmatic cortisol were evaluated. The measurements occurred at intervals of 20 minutes until 2 hours later after the epidural. As of this moment, there were measurements at 6. 12 and 24 hours. There was a significant reduction in the cardiac frequency in 60% of the surveyed in the xylazine group after two hours of epidural administration of the drug. All the groups presented a decrease in the retal temperature after M2. The levels of cortisol presented inferior values at GM if compared to the GX after the epidural treatment. At both Morphine and xylazine groups, respectively, 20 of the animals vomitted, with behavioral alterations such as feeding refusal, posture alterations and posture regarding the environment, as well...(Complete abstract, access undermentioned eletronic address)
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Leão, Marcos George de Souza. "Controle da dor pós-operatória em pacientes submetidos à reconstrução do ligamento cruzado anterior do joelho: comparação de soluções analgésicas intra-articulares". Universidade Federal do Amazonas, 2017. http://tede.ufam.edu.br/handle/tede/5542.
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Dissertação - Marcos G. S. Leão.pdf: 9887937 bytes, checksum: 47ea5adffb4ea4c5feb13fe88c147c65 (MD5)Made available in DSpace on 2017-03-03T10:32:01Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação - Marcos G. S. Leão.pdf: 9887937 bytes, checksum: 47ea5adffb4ea4c5feb13fe88c147c65 (MD5) Previous issue date: 2017-02-17
JUSTIFICATION: Knee Surgery cause postoperative functional disability due to pain. The anterior cruciate ligament (ACL) injury can lead to a catastrophic future effect in the knees, because this ligament is essential for proper joint function. The treatment of choice for active patients with gross instability is arthroscopic ACL reconstruction (ACLR). The ACLR aims to stabilize the knee through reproduction of ligament anatomy, thus reducing the potential adverse effects of intra-articular late sequels. The appropriate management of postoperative pain in the early days after surgery should be a common concern of the orthopedic surgeon, anesthesiologist, patient and physiotherapist. The intraarticular injection of analgesics (IA) is one of techniques employed to control postoperative pain in patients undergoing knee arthroscopy. Bupivacaine is a local anesthetic administered IA by some orthopedic surgeons to avoid acute pain, in this type of surgery. Techniques to control the surgery postoperative pain present the potential to reduce the time of hospitalar stay, confer lower cost to the treatment and abbreviate the patient return to activities and the complete joint functional recovery. OBJECTIVES: This research aimed to evaluate postoperative pain in patients undergoing ACL reconstruction using the analogic visual scale (AVS) who received analgesic IA solutions and specific objectives to assess what analgesic solution is more effective to control postoperative pain and evaluate in which periods there is a better pain control, the solutions side effects and the analgesic consumption. METHODS: A triple blinded randomized clinical trial, was performed at the Serviço de Cirurgia do Joelho da Fundação Hospital Adriano Jorge, Manaus, Amazonas, Brazil, with forty-eight patients who underwent ACL reconstruction randomized into 4 groups: Group I (n = 12) 20 ml of normal saline (control); Group II (n = 12) 20 ml of 0.5% bupivacaine; Group III (n = 12) 20 ml of 0.5% bupivacaine + 0.1 mg of epinephrine; Group IV (n = 12) 20 ml of normal saline + 0.1 mg of epinephrine injected into the knee at the end of the operation before the tourniquet deflation. Pain was assessed by visual analogue scale immediately after, six, 12, 24 and 48 hours after surgery, as well the other variables seen in the objectives. RESULTS: The great variability of the AVS results was observed among the patients evaluated in each group. It was found by Kruskal-Wallis ANOVA, considering a 5% level of significance, the analgesic IA solutions of each group influence the assessment of patients pain (p = 0.003), and the Group 3 had patients with lower postoperative pain. It did not revealed a greater or lesser consumption of supplementary analgesic drugs. CONCLUSIONS: It was concluded that the combination of bupivacaine and epinephrine solution is the most effective clinically in pain control in patients undergoing ACL reconstruction, but has no statistical difference with the Group III (p = 0,547), and was not observed in this study decrease or increase in consumption of additional analgesics as well as their adverse effects (p > 0,05).
JUSTIFICATIVA: Intervenções cirúrgicas sobre o joelho são causa de incapacidade funcional pós-operatória devido à dor. A ruptura do ligamento cruzado anterior (LCA) pode ter um efeito deletério a longo prazo, pois ele é essencial para a função adequada da articulação. O tratamento de eleição para os pacientes ativos e instabilidade do joelho é a reconstrução artroscópica do LCA (RLCA). A RLCA tem como objetivo estabilizar o joelho por meio da reprodução da anatomia ligamentar, reduzindo assim o potencial efeito adverso das sequelas das lesões intra-articulares tardias. O manejo apropriado da dor pós-operatória nos primeiros dias após a cirurgia é uma preocupação comum do cirurgião ortopédico, do anestesiologista, do paciente e do fisioterapeuta. A bupivacaína é um anestésico local, administrado IA por alguns cirurgiões ortopédicos, a fim de prevenir a dor aguda nesse tipo de cirurgia. Técnicas para controlar a dor pós-operatória das cirurgias apresentam o potencial de diminuir o tempo de internação pós-operatório, conferir menor custo ao tratamento e abreviar o retorno do paciente a atividades e a recuperação funcional do joelho operado. OBJETIVOS: Avaliar a dor pós-operatória, nos pacientes submetidos à RLCA que receberam soluções analgésicas intra-articulares; objetivos específicos: verificar qual solução analgésica é mais eficaz no controle da dor pós-operatória, quais períodos existe melhor controle da dor pós-operatória, quais são os potenciais efeitos adversos dessas soluções, assinalar a quantidade de medicações adjuvantes analgésicas e anti-inflamatórias utilizadas, verificar os efeitos sistêmicos adversos causados pelas medicações analgésicas e antiinflamatórias e existência ou não de relação com as soluções. METODOLOGIA: Foi realizado um ensaio clínico randomizado, triplo cego, no Serviço de Cirurgia do Joelho da Fundação Hospital Adriano Jorge em Manaus, com 48 pacientes que foram submetidos à RLCA, divididos aleatoriamente em 4 grupos: Grupo I (n=12) 20 ml de solução fisiológica (controle); Grupo II (n=12) 20ml de bupivacaína a 0,5%; Grupo III (n=12) 20 ml de bupivacaína a 0,5% + 0,1 mg de epinefrina; Grupo IV (n=12) 20 ml de solução fisiológica + 0,1 mg de epinefrina, injetados no joelho ao término da operação antes da desinsuflação do torniquete. A dor foi avaliada pela escala visual analógica imediatamente após o procedimento, e seis, 12, 24 e 48 horas ao fim da cirurgia, bem como as variáveis descritas nos objetivos. RESULTADOS: Observou-se a grande variabilidade dos resultados da EVA entre os pacientes avaliados em cada grupo. Nesse sentido, verificou-se, pela ANOVA de Kruskal-Wallis, considerando um nível de 5% de significância, que as soluções analgésicas IA de cada grupo influenciaram na avaliação da dor desses pacientes (𝑝 = 0,003), sendo os pacientes do Grupo III os que apresentaram menor dor pós-operatória. Não se evidenciou um maior ou menor consumo de drogas analgésicas suplementares, bem como efeitos adversos das decorrentes das soluções empregadas. CONCLUSÕES: A solução combinada de bupivacaína e epinefrina foi a mais eficaz no controle da dor nos pacientes que foram submetidos à RLCA, porém sem diferenças estatisticamente significativas com o grupo II (p = 0,547); não se observou diminuição ou aumento no consumo de analgésicos suplementares nem aparecimento de efeitos sistêmicos adversos (p > 0,05).
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Mendonça, Andreza Carvalho Rabelo. "Efeito da eletroanalgesia no controle da disestesia em mulheres submetidas a linfonodectomia axilar". Universidade Federal de Sergipe, 2013. https://ri.ufs.br/handle/riufs/3762.
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Surgical treatment of breast cancer brings many complications such as dysesthesia at the intercostal nerve dermatome (NICB) due to manipulation of the axillary region. As a treatment for abnormal sensitivity, transcutaneous electrical stimulation (TENS) has been used in other neuropathic injuries. The aim of this study was to evaluate the effect of TENS on dysesthesia caused by an injury in the NICB in women undergoing to axillary lymphadenectomy (LA). This is a placebo-controlled, randomized, double blind clinical trial in involved 32 women who underwent to LA and showed dysesthesia, 16 patients were randomly allocated to active TENS group and 16 in the other group placebo TENS. The instruments used to measure pain were the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire (MPQ-Br). Cutaneous and pressure pain threshold were assessed by using esthesiometry and pressure algometry, respectively. Current amplitude of the electrical pulse was recorded along the 20 sessions. The measurement of quality of life was performed by using the EORTC QLQ-C3O (European Organisation for Research and Treatment of Cancer Quality of Life), followed by its specific module EORTC QLQ-BR23. It was observed that the intensity of sensory discomfort decreased only in the group treated with active TENS when compared to placebo (p<0.06). There was a significant reduction of the pain index and the number of words chosen in the active TENS group when analyzing both paired and independent measurements (p=0.003 and p=0.05). The amplitude of the electric current significantly increased in the active TENS group (p<0.006). No differences were observed in cutaneous threshold, however, there was significant reduction in the pressure pain threshold in the placebo TENS group (p<0.001). Regarding to the quality of life, there was a significant decrease of the domain scores overall health of the EORTC QLQ-C30 in the placebo TENS group (p<0.022), with no significant differences for scores of EORTC QLQ-BR23. It is concluded that TENS reduced the intensity of discomfort in the NICB dermatome, and over time, it was possible to administer higher amplitude of current in the group of TENS active. However, no improvement was observed in the characterization of discomfort in the skin and pressure pain thresholds and quality of life.O tratamento cirúrgico do câncer de mama traz diversas complicações, dentre elas temos a disestesia no dermátomo do nervo intercostobraquial (NICB) devido à manipulação da região axilar. Como forma de tratamento para alteração de sensibilidade, a Eletroestimulação Nervosa Transcutânea (TENS) tem sido utilizada em outras lesões neuropáticas. O objetivo deste estudo foi avaliar o efeito da TENS na disestesia provocada pela lesão do NICB em mulheres submetidas à linfonodectomia axilar (LA). Trata-se de um ensaio clínico controlado por placebo, com distribuição aleatória e duplamente encoberto, em que foram avaliadas 32 mulheres que realizaram LA e apresentaram disestesia, 16 pacientes foram aleatoriamente alocadas no grupo TENS ativa e outras 16 no grupo TENS placebo. Os instrumentos utilizados para análise da dor foram a Escala Visual Analógica (EVA) e o questionário de dor de McGill (Br-MPQ). Os limiares cutâneo e de dor por pressão foram avaliados por meio de estesiometria e algometria, respectivamente. Foi avaliada a amplitude da corrente elétrica ao longo das 20 sessões. A mensuração da qualidade de vida foi realizada por meio do EORTC QLQ-C3O (European Organisation for Research and Treatment of Cancer Quality of Life), seguido do seu módulo específico EORTC QLQ-BR23. Foi observado que a intensidade de desconforto sensitivo diminuiu apenas no grupo tratado com TENS ativa quando comparado ao placebo (p<0,06). Houve redução significativa do índice de dor e do número de palavras escolhidas no grupo TENS ativa quando analisadas medidas pareadas e independentes (p=0,003 e p=0,05). A amplitude da corrente elétrica aumentou significativamente no grupo TENS ativa (p<0,006). Não foram observadas diferenças no limiar cutâneo, entretanto, observou-se redução significativa do limiar de dor por pressão no grupo TENS placebo (p<0,001). Com relação a qualidade de vida, houve diminuição significativa dos escores do domínio estado de saúde global do EORTC QLQ-C30 no grupo TENS placebo (p<0,022), sem diferenças significativas para os escores do EORTC QLQ-BR23. Conclui-se que a TENS diminuiu a intensidade de desconforto no dermátomo do NICB e, ao longo do tempo, foi possível administrar maior amplitude de corrente elétrica no grupo da TENS ativa. No entanto, não foi evidenciada melhora na caracterização do desconforto, nos limiares cutâneo e de dor por pressão e também na qualidade de vida.
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Santini, Manuela Favarin. "Comparação entre duas associações de analgésicos não opioides e opioides no controle da dor do abscesso dentoalveolar agudo em evolução : um ensaio clínico randomizado". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/116478.
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Objetivos: Avaliar o manejo da dor em Endodontia por meio de dois estudos: Artigo 1 – um ensaio clínico randomizado comparando a eficácia analgésica de duas associações de opioide e não opioide no controle da dor do Abscesso Dentoalveolar Agudo (ADA) em evolução; Artigo 2 – uma revisão sistemática investigando a eficácia e segurança de terapia sistêmica para o tratamento da dor de origem endodôntica. Métodos: No Artigo 1, foram incluídos 24 pacientes que procuraram atendimento em serviço odontológico universitário do sul do Brasil. Após o atendimento de urgência, os pacientes foram alocados em dois grupos: Co/Pa – prescrição da associação de codeína (30 mg) e paracetamol (500 mg), por via oral, a cada 4 h, por 3 dias; Tr/Pa - prescrição da associação de cloridrato de tramadol (37,5 mg) e paracetamol (500 mg), na mesma posologia do grupo anterior. Os escores de dor foram registrados pelo próprio paciente, nos tempos 6, 12, 24, 48 e 72 h após o atendimento, em diário específico de evolução da dor, por meio da Escala Analógica Visual (EAV). No Artigo 2, foi realizada uma revisão sistemática, por meio de buscas conduzidas nas bases de dados: MEDLINE, registro de ensaios clínicos da Cochrane Library, LILACS, SciELO, banco de teses/dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e referências dos artigos encontrados. Para serem incluídos, os artigos deveriam ser ensaios clínicos randomizados (ECRs), controlados e cegos, ou revisões sistemáticas com ou sem metanálise. Deveriam ter um dos braços de terapia constituído por analgésico ou anti-inflamatório, administrado por via oral, para controle da dor moderada a intensa, de origem endodôntica, mensurada por meio da Escala Analógica Visual, em adultos. Foram coletados dados referentes às características da amostra, escores de dor pré-tratamento, características dos grupos em comparação, aspectos de qualidade metodológica, frequência de uso de analgésico adicional e a frequência de eventos adversos. Foram realizadas análises descritiva e inferencial. Resultados: No Artigo 1, em ambos os grupos, houve redução dos escores de dor ao longo do tempo. No grupo Co/Pa, houve redução significativa dos escores em 12, 24, 48 e 72 horas, em comparação com aos iniciais (P<0,05). Os escores em 48 e 72 horas foram menores, em relação aos iniciais e aos escores das 6 horas (P<0,05). No grupo Tr/Pa, houve redução dos escores de todos os tempos experimentais, em relação aos iniciais (P<0,05). Para todos os intervalos de tempo analisados, os grupos não foram diferentes entre si (P>0,05). Ambos os tratamentos foram eficazes no controle da dor provocada pelo ADA em evolução. Porém, a associação Tr/Pa apresentou-se menos segura. No Artigo 2, de um total de 431 referências, 419 resumos foram analisados e 14 artigos foram lidos na íntegra. Após a exclusão de 5 artigos, 9 ensaios clínicos preencheram os critérios de inclusão. Os estudos compararam paracetamol, AINE (ibuprofeno, flurbiprofeno, cetorolaco de trometamina, etodolaco, tenoxicam), prednisolona, tramadol e associações analgésicas no tratamento da dor endodôntica moderada a intensa. Foi observado que os medicamentos foram administrados antes ou após a intervenção endodôntica. Em 8 estudos, o grupo controle foi placebo e 8 estudos utilizaram o esquema de dose única para avaliar o controle da dor. Em todos os ensaios clínicos, o desfecho primário analisado foi a redução dos escores de dor e os desfechos secundários, uso de medicamento adicional e ocorrência de reações adversas. Foi possível estabelecer uma relação significativa entre uso de analgésico adicional e diagnóstico periapical. Quando a administração ocorreu antes do procedimento endodôntico, não foi observada a ocorrência de eventos adversos. Quando a administração ocorreu após o procedimento, foram relatadas reações adversas em dois dos três estudos incluídos na análise. Conclusão: O Artigo 1 sugere que, em função de eficácia analgésica e segurança, a associação codeína/paracetamol seja mais efetiva para o controle da dor aguda de moderada a intensa, no tratamento da ADA em evolução. O Artigo 2 aponta carência de ECRs em Endodontia, que utilizem um mesmo padrão metodológico, para definição de um protocolo de tratamento sistêmico na dor de origem endodôntica.Aim: To evaluate the management of pain in Endodontics by two studies: Article 1 - a randomized clinical trial comparing the analgesic efficacy of two opioids and non-opioid associations in the pain control of Acute Dentoalveolar Abscess (ADA); Article 2 - a systematic review investigating the efficacy and safety of analgesic therapy in the management endodontic pain.Methodology: The Article 1 included 24 patients that looked for emergency treatment in a university dental clinic. These patients were divided into two groups: Co / Pa - prescription of codeine (30 mg) + acetaminophen (500 mg) oral, every 4 h, during 3 days; Tr / Ac - prescription of tramadol hydrochloride (37.5 mg) + acetaminophen (500 mg) as the previous group. Pain scores were recorded by the patient at 6, 12, 24, 48, and 72 h after treatment, in a pain diary, using the Visual Analogue Scale (VAS). The Article 2 was conducted in electronic databases, gray literature, and references of retrieved articles to analyze randomized clinical trials or systematic reviews with or without meta-analysis. One arms of the therapy should have comprised an anti-inflammatory or analgesic drugs, orally administered by adults, in order to control moderate to severe pain, measured by Visual Analogue Scale, cause by endodontic problems . Data were collected regarding the characteristics of the sample, scores of pretreatment pain, characteristics of compared groups, methodological quality aspects, additional analgesic use, and frequency of adverse events. Descriptive and inferential analyzes were performed. Results: In Article 1, in both groups there was a reduction in the pain scores over time. For Co/Ac group, it was found a significant reduction in the scores at 12, 24, 48, and 72 hours after treatment (P <0.05). The scores at 48 and 72 hours were lower, compared to immediate treatment and scores at 6 hours after treatment (P <0.05). In the Tr/ Ac group, the scores decreased as the time is increasing (P <0.05). For all time intervals tested, the groups were not significantly different (P> 0.05). Both treatments were effective in controlling pain caused by ADA. The association Tr/ Ac presented itself less secure. In Article 2, a total of 431 references and 419 abstracts were reviewed, then only 14 articles were read in full. From these articles it was excluded 5 and 9 trials met the inclusion criteria. These studies compared acetaminophen, NSAIDs (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, and tenoxicam), prednisolone, and analgesic tramadol associations for treating moderate to severe endodontic pain. It was observed that drugs were administered before or after endodontic therapy. In 8 studies, the control group was placebo and 8 studies used single dose regimen to assess pain control. In all clinical trials, the primary outcome analyzed was the reduction of scores in pain and secondary outcomes were the utilization of additional medication and adverse reactions. It was possible to establish a significant relationship between use of additional analgesics and periapical diagnosis. When the administration occurred before the endodontic procedure no adverse events were observed. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis. Conclusion: The Article 1 suggests that, considering analgesic efficacy and safety function, the association codeine/ acetaminophen is more effective for the control moderate to severe pain, at the treatment of ADA in evolution. The Article 2 found that there is a lack of RCTs in Endodontics using the same methodological standard to define a systemic treatment protocol of endodontic pain.
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Oliveira, Rohnelt Machado de. "Influencia do controle da dor por bloqueio espinhal na incidencia de complicaçoes cardiovasculares no pós-operatório de pacientes submetidos a cirurgias de grande porte em abdome superior e tórax, sob anestesia geral". reponame:Repositório Institucional da UFPR, 2012. http://hdl.handle.net/1884/2881.
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Volmanen, P. (Petri). "Intravenous patient controlled analgesia with remifentanil in early labour". Doctoral thesis, University of Oulu, 2010. http://urn.fi/urn:isbn:9789514261176.
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Abstract
In four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0–10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0–4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.
Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression.
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Smith, Karen. "Patient controlled analgesia and the assessment and control of pain in a coronary care unit". Thesis, Abertay University, 1996. https://rke.abertay.ac.uk/en/studentTheses/69995a13-827c-4f22-8373-7efabf55bb88.
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Coronary Heart Disease (CHD) is one of the major causes of morbidity and mortality in Scotland. One of the most frequently reported symptoms of CHD is chest pain which is often of sudden onset and severe in nature. The control of pain presents a challenge to nursing and medical staff as patients experience ongoing pain. This study sought to investigate the assessment and treatment of cardiac pain in a coronary care unit (CCU). Adequate assessment of pain is a fundamental step in its management. Within this study the process of communication with patients who had cardiac pain was assessed by measuring the duration, frequency and content of verbal communication between nurses and patients. Following attendance at an educational programme the staffs' behaviour was reassessed to evaluate any change. No significant difference was observed in the duration or frequency of interaction, but a change was observed in the quality of communication which occurred during pain assessment and the subsequent administration of opiates in CCU. Having attempted to improve the practice of nursing staff, a comparison of patient controlled analgesia (PCA) versus nurse administered analgesia for pain following myocardial infarction was performed for 48 hours. A significant reduction in pain intensity was reported in the PCA group. The PCA group also used significantly more analgesics particularly in the second 24 hour period. The use of PCA clearly demonstrated the problem of ongoing pain following myocardial infarction. An exploration of the levels of urinary catechoalmine secretion as an objective measure of pain was found to show no relationship to pain experience. The patients' views on the management of their pain and opinions of PCA was also explored. The results suggested that PCA removed the obstacles associated with the administration of analgesia in the conventional regime. It was readily accepted by both patients and staff in CCU and could be easily offered as a treatment option in the management of cardiac pain. This study has generated areas for further investigation which include the influence of alternative education strategies on pain management and the evaluation of PCA with other client groups, and in different clinical settings.
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Robinson, Susan. "Patient-controlled analgesia in the postoperative period". Thesis, University of Leicester, 1995. http://hdl.handle.net/2381/34214.
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Patient-controlled delivery systems deliver drugs at a rate which is controlled by the patient in order to achieve plasma concentrations consistent with acceptable efficacy and minimal side-effects. They can be used therapeutically to provide pain relief after surgery and as a research tool to measure the efficacy of other analgesic techniques. Patient-controlled analgesia (PCA) was investigated in the postoperative period. Comparative studies of PCA devices revealed little difference in terms of clinician and patient satisfaction. As a research tool, PCA proved useful in evaluating alternative methods of providing postoperative analgesia. Ambulatory PCA devices were more portable (p=0.01) on the first postoperative day with less nausea (p=0.02) on the second. Mean (SEM) postoperative morphine requirements were 82.9 (9.8) mg and 120.6 (17.5) mg for the ambulatory and bedside PCAS respectively (p=0.06). Mean (SEM) postoperative morphine consumption between the electronic 35.1 (8.5) mg and nonelectronic devices 35.7 (6.6) mg were similar (p=0.77). In evaluating other methods of analgesia, there was no significant difference between active and placebo TCENS. Mean (SEM) postoperative opioid requirements were 35.6 (5.3) mg and 31.6 (3.5) mg for the active and placebo groups respectively (p=0.5). Subcutaneous wound infiltration with bupivacaine 0.5% also failed to decrease mean (SEM) opioid requirements for the first postoperative day, which were 56.7 (6.1) mg and 67.3 (6.4) mg for the bupivacaine and saline groups respectively (p=0.89). When diamorphine and morphine were compared for dose and effect, the postoperative mean (SEM) requirements were 20.2 (2.4) mg and 44 (6.8) mg respectively (p=0.004). No significant differences were found in side-effects. After PCA and i.m. morphine no differences were detected in mean (SEM) postoperative consumption - 34.8 (5.0) mg and 30.2 (6.7) mg in the PCA and i.m. groups respectively (p=0.17). Overall requirements for antiemetics were not significant (p=0.69). In the PCA group, 53% patients did not vomit, were not nauseated and did not require antiemetics compared with 27% patients in the i.m. group (p=0.14).
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Laurila, née Kostamovaara P. (Päivi). "Pain relief after joint surgery:a clinical study". Doctoral thesis, University of Oulu, 2002. http://urn.fi/urn:isbn:9514267958.
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Abstract
Excessive pain after surgery causes many kinds of endocrine, metabolic and inflammatory responses, which may increase postoperative morbidity and mortality - especially among elderly patients. This study evaluated the effect of peripheral and central pain relief techniques after joint surgery.
Intravenously administered doses of 100 mg, 200 mg and 300 mg of ketoprofen decreased the requirement for opioid (fentanyl) in a dose-dependent manner by 38%, 45% and 53%, respectively, compared with a placebo, without any noticeable ceiling-effect, when administered after hip and knee arthroplasty. Patients receiving a 300 mg dose of ketoprofen had significantly lower postoperative pain scores than those receiving a placebo. There were no significant differences in incidences of nausea and vomiting, or in the amount of bleeding between the ketoprofen and placebo groups.
Intravenous doses of 200 mg of ketoprofen, 150 mg of diclofenac, and 120 mg of ketorolac produced similar postoperative pain scores and requirement for opioid (fentanyl) with no intergroup differences in the incidence of nausea and vomiting and in the amount of bleeding, when administered after hip arthroplasty.
The addition of ropivacaine, 1 mg·ml-1, did not decrease the requirement for epidural fentanyl administered via a patient-controlled analgesia device for postoperative pain relief after hip arthroplasty. Both drug infusions provided effective pain relief. The most common adverse effect was pruritus, which occurred in a similar number of patients in both groups.
An interscalene brachial plexus block with ropivacaine decreased the dose of PCA-delivered oxycodone by 78% after arthroscopic shoulder surgery while subacromial bursa blockade with ropivacaine decreased it by only 11 % compared to a placebo during the 20 hour study period. Postoperative pain scores were significantly lowest with a interscalene brachial plexus block.
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Chumbley, Gillian Mary. "Patients' evaluation of patient controlled analgesia after surgery". Thesis, St George's, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249438.
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Pedro, Eduardo Amorim Gonçalves. "Estudo da Analgesia Induzida pelo Exercício na Dor Lombar Crónica". Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/29334.
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Relatório do Projecto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo-EsqueléticasIntrodução: A Dor Lombar Crónica (DLC) é a principal causa mundial de anos vividos com incapacidade e a disfunção músculo-esquelética mais prevalente em Portugal. As recomendações apontam o exercício terapêutico como primeira estratégia de intervenção, mas a evidência destaca o reduzido impacto deste a médio e longo prazo nos principais indicadores clínicos. Os seus mecanismos de acção são um alvo de estudo relevante para melhorar a sua aplicação terapêutica e aprofundar a caracterização da DLC. Objectivo: Estudar os indicadores de hipoalgesia induzida pelo exercício (EIH) e os parâmetros somatossensoriais de uma amostra com DLC, após a realização de um programa de exercício de controlo motor. Metodologia: Realizou-se um estudo exploratório com um desenho “pré-pós” intervenção numa amostra de 11 sujeitos com DLC. O protocolo de intervenção tratou-se de um programa de 12 sessões de exercício de controlo motor e foram avaliados indicadores clínicos, psicossociais e somatossensoriais, antes e após a aplicação do protocolo de intervenção. Resultados: Observou-se uma redução na intensidade da dor e incapacidade dos participantes, bem como a melhoria dos indicadores psicossociais (p<0.05). Adicionalmente, observaram-se aumentos dos limiares térmicos de dor na região lombar, diminuições dos limiares de detecção térmica na mão e redução da somação temporal na região lombar (p<0.05). No entanto, o exercício não promoveu a activação dos mecanismos inibitórios endógenos da dor. Conclusão: Os resultados sugerem que um programa de exercícios de controlo motor que apresenta efeitos hipoalgésicos também promoveu alterações nas características somatossensoriais numa amostra de sujeitos com DLC. A análise dos dados indica que a EIH ocorreu predominantemente nas vias periféricas e segmentares. Pelas limitações metodológicas presentes, os resultados deste estudo deverão ser interpretados cuidadosamente, mas os resultados justificam a investigação no tópico da EIH na DLC para melhor caracterizar os mecanismos de acção das diferentes modalidades de exercício terapêutico recomendados nesta disfunção.
Introduction: Chronic Low Back Pain (CLBP) is the main cause of years lived with disability worldwide and the most prevalent musculoskeletal condition in Portugal. Guidelines recommend therapeutic exercise as the first line of intervention, but the scientific evidence highlights its reduced impact at mid- and long-term on the main clinical outcomes. Its mechanisms of action are a topic of interest in investigation aiming to improve its applicability and the characterization of CLBP. Aim: To study the indicators of exercise induced hypoalgesia (EIH) and the somatosensory parameters of a CLBP sample, after a motor control exercise program. Methods: A single-arm interventional exploratory study was conducted on a sample of 11 subjects with CLBP. The intervention protocol was a 12 session program of motor control exercise with the assessment of clinical, psychosocial and somatosensory outcomes, before and after the completion of the protocol. Results: The results show a reduction on the participants’ reported pain intensity and disability, as well an improvement of the psychosocial outcomes (p<0.05). There was an increase of the thermal pain thresholds on the lumbar area, a decrease of the thermal detection thresholds on the hand and a decrease of the temporal summation on the lumbar area (p<0.05). However, the exercise program didn’t activate the pain endogenous inhibitory mechanisms. Сonclusions: This study suggests that a motor control exercise program which promotes hypoalgesic effects also improves the somatosensory characteristics of a sample of subjects with CLBP. The results show that EIH has occurred mainly on the peripheral and segmentary nervous pathways. Due to the methodological limitations of this study, the results should be interpreted carefully. Nevertheless, these results justify further investigation about EIH on CLBP in order to better understand the mechanisms of action of the many therapeutic exercise modalities recommended for this condition.
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Holmér, Pettersson Pia. "Pain treatment after surgery : with special reference to patient-controlled analgesia, early extubation and the use of paracetamol /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-134-2.
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Twomey, Mary. "Post operative pain-patient controlled analgesia and patient satisfaction /". Staten Island, N.Y. : [s.n.], 2000. http://library.wagner.edu/theses/nursing/2000/thesis_nur_2000_twome_post.pdf.
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Irwin, Michael Garnet. "Patient maintained drug delivery". Thesis, Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31981847.
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PEROL, ERIC. "L'analgesie controlee par le patient en neurochirurgie". Besançon, 1994. http://www.theses.fr/1994BESA3008.
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Thomas, Veronica J. "Personality characteristics of patients and the effectiveness of patient controlled analgesia". Thesis, University of London, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261202.
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One of the most exciting developments within postoperative pain research in recent years has been the introduction of Patient Controlled Analgesia (PCA). PCA is a technique in which patients self-administer small doses of opioids intravenously and it has been shown to be more effective than the conventional intramuscular injection method (IMI). However, PCA requires costly equipment and this necessarily places constraints on its availability. Therefore it is vital to ensure that the PCA facilities which are available are used as efficiently as possible. Essential to this is an understanding of the categories of patients for whom it will be most effective. At present the basis of selection of patients for PCA is often unclear. Frequently anaesthetists use the extent of trauma as a guide, although there is no evidence that this is the most effective strategy. Moreover, it ignores numerous factors which empirical research has shown to influence the experience of postoperative pain. These include state and trait anxiety, neuroticism and coping style. Until now their importance has only been investigated within the IMI analgesic regime. The present thesis remedies this omission by investigating pain/personality relationships under both PCA and IMI regimes. A particular interest was the identification of ways of detecting the patients who would benefit most from the use of PCA in terms of personality profiles. This study investigated whether knowledge of the patient characteristics of state anxiety and trait anxiety, neuroticism and coping style can be used to predict which patients will benefit the most from PCA. This research involved two main studies, in which a sample of 164 adult female and male patients undergoing major elective surgery were preoperatively assessed in terms of anxiety, neuroticism and coping style. Postoperatively they were allocated to either PCA or IMI analgesic regimes and their pain experience was assessed at 6,18 and 24 hours after surgery. The data were analyzed using Pearson's Correlations, T tests, Analysis of Variance and Multiple Regression. The findings revealed that state anxiety and coping style were significant predictors of postoperative pain for PCA as well as IMI regimes. Patients using PCA experienced significantly better pain relief than did their IMI counterparts. However, it was the patients with high levels of state anxiety using PCA who benefited the most. The superior pain control of PCA was not found to be related to the presence of the technically sophisticated PCA machine. PCA was also associated with a reduction in the length of hospital stay and a saving of nursing time on the ward. Patients had positive reactions about being in control of their pain relief, whilst staff felt that patient control was beneficial. They were also impressed by the time saving element of PCA. The implications for the management of post operative pain and the financial saving are considered.
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Sowden, Michelle. "Individual differences in response to patient controlled analgesia : development and evaluation of a feedback model". Thesis, University of Surrey, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308550.
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Njo, Kui-hung Anthony y 梁居雄. "Postoperative patient controlled epidural analgesia after total knee arthroplasty with 2ug/ml fentanyl combine with 0.2% ropivacaine or0.2% levobupivcaine: double-blindedequivalence randomized controlled trial and cost-effectivenessanalysis". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45173631.
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Machoki, Mugambi Stanley. "Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control : a randomised control trial". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/13787.
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Post-operative analgesia currently relies on multimodal therapy including epidural analgesia, intravenous morphine and/or paracetamol (Perfalgan ®) infusion. Local wound infusion has been effectively utilized in adults with promising results but has not been prospectively tested in children undergoing different abdominal operations. The aim of this study was to compare continuous local anesthetic wound infusion to the current standard of care in post-operative pain control in children. Methods: We conducted a prospective randomized, pain assessor blinded trial comparing Bupivacaine wound infusion {Continuous Local Anaesthetic Wound Infusion - CLAWI) in addition to intravenous paracetamol (Perfalgan®) and morphine for rescue analgesia. This was compared to: (a) epidural bupivacaine plus intravenous morphine and Perfalgan® [EPI] for children undergoing open abdominal surgery and (b) intravenous morphine and Perfalgan® infusion alone [standard post-operative analgesia - SAPA] in children undergoing Lanz incision laparotomy for complicated appendicitis. Patients aged between 3 months and 12 years undergoing laparotomy or open appendectomy were randomly selected for local anesthetic wound infusion (CLAWI) versus EPI or CLAWI versus (SAPA) respectively. Exclusion criteria were neurological impairment, post-operative ventilation and history of adverse reaction to bupivacaine. Consent from the guardian, assent from patients above the age of 7 years and ethics approval from the University of Cape Town Human Ethics Research Committee was obtained. The wound infusion catheter ('lnfiltralLong', PANJUNK®) was placed sub-fascially after suture of the peritoneum and 0.2 % bupivacaine 2mls/kg infused on anesthetic reversal followed by 0.2ml/kg/hour thereafter for 48 hours. Pain assessments were performed for each patient at regular intervals by a single assessor who had training in pediatric pain management and who was blinded to the group allocation. The duration of surgery, length of incision, perioperative antibiotics, wound class risk of surgical site infection, time to return to full feeds, drug reactions; hospital stay, surgical site infection and wound catheter and epidural catheter complications were recorded for each patient. Primary outcome measure was total morphine used in the appendectomy-SAPA vs appendectomy-CLAW! group and rescue morphine requirements in the laparotomy-EPI vs laparotomy-CLAWI group. The secondary outcomes were pain control as measured using the FLACC scale, time to full feeds, mobilization and requirement for urinary catheter.
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Torres, Perez Jose Vicente. "Emerging targets for analgesics to control inflammatory pain". Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/55115.
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Burn injury is followed by one of the most severe inflammatory conditions and associated with one of the most excruciating persistent pain. Current therapeutics for burn injury-associated pain are limited and produce undesired side effects. The development and particularly the maintenance of persistent pain depend on plastic changes in neurons involved in the processing of noxious stimulation-evoked (nociceptive) information including nociceptive primary sensory neurons and spinal dorsal horn neurons. Those plastic changes include changes in gene expression that are regulated largely by epigenetic mechanisms including post-translational modification of histones. Here, I show inflammatory conditions including that following burn injury significantly and specifically up-regulates, both in a group of primary sensory neurons and spinal dorsal horn neurons, the expression of phosphorylated serine 10 in histone H3 (pS10H3), a transcriptionally permissive histone mark. This up-regulation is associated, in superficial spinal cord neurons, with up-regulation in the expression of cFos a known marker for nociceptive processing. In superficial spinal cord neurons, these up-regulations depend on the activation of the N-methyl-D aspartate receptor, extracellular signal-regulated kinase 1 and 2 and mitogen and stress-activated kinase 1 and 2 (MSK1/2). Importantly, deletion of MSK1/2 blocks the development of inflammatory heat hyperalgesia. Further, blocking the voltage-gated sodium channel type 1.7 significantly reduces pS10H3 up-regulation both in primary sensory neurons and superficial spinal dorsal horn neurons. I conclude that pS10H3 represents a novel marker for nociceptive processing both in primary sensory and superficial spinal dorsal horn neurons, and transcriptional changes downstream of S10H3 phosphorylation are pivotal in the development of inflammatory heat hyperalgesia. I further conclude that Nav1.7 is a promising target for the control of heat hyperalgesia in burn injury.
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Doyle, Edward. "Investigation of patient-controlled analgesia for the treatment of postoperative pain in children". Thesis, University of Edinburgh, 1996. http://hdl.handle.net/1842/21209.
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The work incorporated in this thesis was conceived and carried out with the aim of investigating the efficacy and the incidence of side effects when different regimens for patient-controlled analgesia with morphine sulphate are used in children. Features of interest were the size of the bolus dose, the place of a background infusion and its magnitude, alternatives to the intravenous route of administration and the prevention of postoperative nausea and vomiting. In a comparison of patient-controlled analgesia with and without a background infusion there were no significant differences in the pain scores of the two groups although there were more side effects in the background group. There was also a better sleep pattern in this group. In a comparison of different background infusions, the inclusion of a background infusion of 4 micrograms kg-1 hour-1 did not increase the incidence of side effects and was associated with less hypoxaemia and a better sleep pattern than no background infusion although it did not improve the efficacy of the technique. When pain was assessed after movement, the inclusion of a background infusion of 4 micrograms kg-1 hour-1 improved analgesia and was associated with less hypoxaemia and a better sleep pattern than no background infusion. When bolus doses of 10 micrograms kg-1 and 20 micrograms kg-1 were compared, 20 micrograms kg-1 produced lower pain scores and fewer hypoxaemic episodes than 10 micrograms kg-1. There were no differences between the groups in the incidence of side effects. In comparison of intravenous and subcutaneous infusions for the treatment of postoperative pain there were no differences between the groups in pain scores or the incidence of side effects.
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Long, James Harry. "Control of analgesic and anti-inflammatory pathways by fatty acid amide hydrolase". Thesis, Queen Mary, University of London, 2012. http://qmro.qmul.ac.uk/xmlui/handle/123456789/3124.
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The endogenous cannabinoids (endocannabinoids) arachidonoyl ethanolamide (AEA) and 2-arachidonoyl glycerol (2-AG) regulate neurotransmission and inflammation by activating the CB1 cannabinoid receptors in the central nervous system and the CB2 cannabinoid receptors on immune cells. Endocannabinoids are inactivated via a 2-step process: firstly undergoing reuptake into the cell and then hydrolysis by fatty acid amide hydrolase (FAAH) for AEA or by monoacylglycerol lipase (MAGL) for 2-AG. Inhibition of FAAH is an effective treatment for inflammatory pain and is a target for the development of novel analgesics. FAAH and MAGL produce arachidonic acid by hydrolysis of endocannabinoids. In inflammation arachidonic acid is oxidised by cyclooxygenase 2 (COX-2) to synthesise the prostaglandins. Both FAAH and MAGL inhibition were showed to indirectly suppress prostaglandin E2 synthesis in activated macrophages. This effect was found to be dependent on the amount of lipopolysaccharide used to activate the macrophages. The FAAH substrates, AEA, oleoyl ethanolamide (OEA) and palmitoyl ethanolamide (PEA), were measured in samples from an in vivo model of inflammatory pain to screen various FAAH inhibitors to prove their mechanism of action. Liquid chromatography-tandem mass spectrometry methods were developed and validated for the measurement of these three substrates in brain and whole blood. Blood OEA and PEA concentrations were found to be indicative of brain FAAH activity and brain AEA concentrations. FAAH is capable of conjugating arachidonic acid to paracetamol to form the active metabolite AM404, an inhibitor of AEA reuptake. It was shown that FAAH can also conjugate oleic acid and palmitic acid to paracetamol, producing novel metabolites. A clinical trial was conducted to comprehensively investigate the pharmacokinetics, metabolism and mechanism of action of intravenous paracetamol in cerebrospinal fluid and plasma. Paracetamol, its major metabolites, AM404, prostaglandin E2, leukotriene B4, serotonin and the FAAH substrates were measured. For the first time AM404 was demonstrated to be formed by humans and be present in the cerebrospinal fluid.
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Silvasti, Marja. "Patient-controlled postoperative analgesia : comparison of efficacy, side-effects and safety of various regimens". Helsinki : University of Helsinki, 2001. http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/silvasti/.
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WASNER, NATHALIE. "L'analgesie controlee par le patient dans les algies cancereuses par infusions morphiniques". Besançon, 1992. http://www.theses.fr/1992BESA3052.
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Grönqvist, Hampus y Albin Vahlberg. "Leder patientinformation om PCA-pump till effektiv smärtlindring vid postoperativ vård - en kvantitativ studie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-225287.
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Bakgrund/syfte: Smärtlindring via PCA-pump är en effektiv och säker metod vid postoperativ vård. Den syftar till att ge patienten större möjlighet att påverka sin smärtlindring. Tidigare studier påvisar att många patienter upplever sin kunskap om PCA- pumpen som otillräcklig. Denna studie syftar till att undersöka vilken grad av självskattad kunskap patienter upplever sig ha om PCA-pumpen vid smärtlindring med hjälp av PCA vid postoperativ vård. Dessutom undersöks om utförlig information, både muntlig och skriftlig, leder till ökad kunskap beträffande PCA-pumpen samt om patientinformation om PCA- pumpen minskar patientens självskattade smärta vid smärtlindring med hjälp av PCA-pump postoperativt. Metod: En deskriptiv konsekutiv enkätinsamling genomfördes på fem kirurgavdelningar vid ett sjukhus i mellersta delen av Sverige. 26 patienter deltog i studien. Resultat: Denna studie påvisade ett positivt samband mellan patientinformation och smärtlindring (r = 0,74, p = 0,0005). Det framkom även ett positivt samband mellan att få utförlig information om PCA-pumpen, muntlig och skriftlig, och ökad kunskap om PCA- pumpen hos patienten (r = 0,61, p = 0,0009). Självskattad kunskap om PCA pumpen och dess funktioner var i genomsnitt 6,3/10. Studien påvisade även att kombinerad smärtlindring med PCA-pump och EDA postoperativt leder i genomsnitt till ett VAS-värde som var 1,57 lägre efter administrering, i jämförelse med de som endast hade smärtlindring via PCA-pump, resultatet var dock inte signifikant (p = 0,1). Slutsats: Patientinformation kan spela en stor roll kring smärtlindringen hos patienter med PCA-pump. Utveckling av kvalitetsdokument för hur patientinformationen skall utföras kliniskt kan leda till en ökad smärtlindring hos patienter som vårdas postoperativt med PCA- pump. Mera forskning och större undersökningsgrupper behövs för att styrka generaliserbarheten och validiteten.Background: Pain relief through PCA pump is an effective and safe method for the treatment of postoperative pain. It aims to provide the patient with greater ability to influence their pain. Previous studies shows that many patients experience their knowledge of the PCA pump as inadequate. This study aims to examine the degree of self-assessed knowledge patients feel that they have on the PCA pump during pain treatment through PCA in postoperative care. The study also aims to examine if detailed information, both verbal and written, will lead to increased knowledge regarding the PCA pump and whether extended information about PCA pumps reduces the patients self-rated pain during pain relief through PCA pump postoperatively. Method: A descriptive consecutive survey data collection was conducted on five surgical wards in the middle part of Sweden. 26 patients participated in this survey. Results: This study showed a positive correlation between patients and pain relief (r = 0,74, p = 0,0005). It was also a positive correlation between getting detailed information, both verbal and written, and increased knowledge for the patient (r = 0,61, p = 0,0009). Self-perceived knowledge of the PCA pump and its functions were an average of 6.3/10. The study also showed that combined pain treatment using the PCA-pump and EDA postoperatively leads to an avarage VAS-value that was 1,57 lower after administration, in comparison with those who only had pain treatment through the PCA-pump, the result was not significant (p = 0,1). Conclusion: Patient information can play a big role on pain relief in patients with PCA pump. Development of quality document for how patient information is to be performed clinically may lead to increased pain relief in patients treated postoperatively with PCA pump. More research and larger study groups are needed to demonstrate the generalizability and validity.
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Pillet, François. "Analgesie interpleurale postoperatoire apres oesophagectomie : etude controlee en double aveugle : bupivacaine versus lidocaine". Nantes, 1992. http://www.theses.fr/1992NANT100M.
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Mesas, Idáñez Ángeles. "Guía de práctica clínica para el control del dolor postoperatorio y evaluación de la analgesia postoperatoria". Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/322797.
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El dolor postoperatorio es un problema frecuente en los hospitales. Se han desarrollado Guías de Práctica Clínica para el control del Dolor Postoperatorio (GPCDP) con la finalidad de ayudar a los profesionales sanitarios y mejorar el tratamiento del dolor postoperatorio. Pocos estudios han evaluado el efecto de las GPCDP en la práctica clínica.
OBJETIVOS
El objetivo principal fue evaluar la prevalencia y la intensidad del dolor postoperatorio antes y después de la implementación de la GPCDP. Los objetivos secundarios fueron la evaluación de los registros del dolor, de las pautas analgésicas, y de la satisfacción de los pacientes con el tratamiento analgésico en ambos períodos.
MATERIAL Y MÉTODO
Estudio observacional de diseño antes-después, que incluyó dos estudios transversales realizados en un hospital de tercer nivel en dos períodos. El primer período fue en 2006, antes de la implementación de la GPCDP, y el segundo período en 2011, después de su elaboración y difusión. Se recogió información de variables demográficas y clínicas de los pacientes, y variables farmacológicas a partir de las historias clínicas. Además también se recogió información sobre la intensidad del dolor de los pacientes y del grado de satisfacción mediante una entrevista con los pacientes. Se realizó una comparación de los resultados en los dos períodos.
RESULTADOS
Se incluyeron 306 pacientes en el primer período y 317 en el segundo. No hubo diferencias significativas respecto a las variables demográficas y clínicas de los pacientes en los dos períodos del estudio. La prevalencia del dolor fue menor en el segundo período (77%) que en el primer período (92%) (p<0,05). El dolor más frecuente referido por los pacientes en las últimas 24 horas fue de intensidad moderada o intensa en el 53% de los pacientes del primer período y en el 33% de los pacientes en el segundo (p<0,05). En el segundo período la prescripción de los analgésicos se adecuaron a las recomendaciones de la GPCDP en el 50% de los
pacientes. En el segundo período aumentó la prescripción de paracetamol, AINE y morfina, y de la pautas controladas por el paciente en comparación con el primer período, y disminuyeron las pautas a demanda. No se observó una mayor adherencia a las recomendaciones relacionadas con la dosificación de los analgésicos en el segundo período. En ambos períodos los pacientes manifestaron un grado de satisfacción elevado respecto al alivio del dolor con el tratamiento recibido. Se observó variabilidad de la prevalencia y la intensidad del dolor, y del grado de satisfacción de los pacientes en las diferentes áreas del hospital.
CONCLUSIONES
Tras la elaboración y difusión de la GPCDP se observó un descenso de la prevalencia del dolor y una disminución de la intensidad del dolor de los pacientes. Sin embargo, todavía existe margen de mejora en la adherencia a las recomendaciones de la GPCDP y la disminución de la intensidad del dolor postoperatorio. Son necesarias medidas continuadas de información, formación y evaluación del dolor para conseguir un tratamiento adecuado del dolor postoperatorio a lo largo del tiempo.Introduction: Postoperative pain is a frequent problem in hospitals. Many Clinical Practice Guidelines for Postoperative Pain(CPGPP) control have been developed with the aim of helping health professionals, and improving the postoperative pain treatment. Few studies have evaluated the effect of this CPGPP in clinical practice. Objectives: The main objective is to evaluate the prevalence and the intensity of the postoperative pain, before and after the implementation of the CPGPP. The secondary objectives have been the evaluation of the pain registries, the analgesic schedule, and the grade of satisfaction of the patients after the analgesic treatment in both periods. Material and Methods: The observational study with before and after design, which included two transversal studies, was carried out in a third level hospital in two separate periods. The first period took place in 2006, before the implementation of the CPGPP, and the second period in 2011 after its elaboration and diffusion. Information of demographic and clinical variables from patients, and pharmacological variables were collected from the clinical histories. Furthermore, data over the pain intensity and the degree of satisfaction of patients was collected through a personal interview. A comparison between the two periods was stablished. Results: The study included 306 patients in the first period, and 317 in the second period. There were no significative statistical differences with respect to the demographical and clinical variables of patients in both periods. The prevalence of the pain was smaller in the second period (77%) than in the first period (92%)(p<0,05). The most frequent pain referred to by the patients in the last 24h was moderate or intense pain in 53% of patients in the first period, and was reduced to 33% of patients in the second(p<0,05). In the second period analgesics prescription were adjusted to the recommendations of the CPGPP in 50% of patients. In the second period an increase in the prescription of Paracetamol, AINE and morphine was observed, so were patient controlled analgesia in comparison with the first period, the schedules “as-need” decreased. No increase in the adjustment to the recommendations related to the analgesic dosage was observed in the second period. In both periods the patients expressed a high degree of satisfaction with the pain relief after the received treatment. A variability in the prevalence and intensity in the pain, and the degree of satisfaction of patients in different sections of the hospital were observed. Conclusions: After the elaboration and diffusion of the CPGPP, a decrease in the prevalence of pain and a reduction in patients pain intensity was observed. Nevertheless, there is still room for improvement in the following of the CPGPP recommendations, and the decrease of postoperative pain. There is need for constant information, formation and evaluation of pain analgesics in order to obtain the adequate postoperative pain treatment through time.
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Hughes, Sam. "Endogenous analgesia: temporal and spatial control of the neuropathic pain phenotype by the descending noradrenergic system". Thesis, University of Bristol, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.682352.
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The descending noradrenergic system forms part of the body's endogenous analgesic system, however there are conflicting views as to the exact role the system plays during the development of the neuropathic pain phenotype. The experiments described in this thesis aim to explore the longitudinal changes in descending noradrenergic control following nerve injury and the potential utility of selective noradrenaline re-uptake inhibitors in the treatment of neuropathic pain. All experiments were performed on adult male Wistar rats using a combination of behavioural, immunohistochemical and electromyographical techniques. Using a method chronic intrathecal catheterisation, it was found that administration of an uz adrenoceptor (AR) antagonist at day 3 following nerve injury revealed the early onset of allodynia and hyperalgesia. However, as the phenotype progressed, uz-AR antagonism had no effect over allodynia however could still modulate heat hyperalgesia. There was also a reduced noradrenergic innervation to the lumbar dorsal horn in nerve injured rats. Combined, this suggested a progressive failure of the noradrenergic system to prevent the onset of ipsilateral behavioural hypersensitivity. Interestingly, uz-AR antagonism also unmasked contralateral allodynia and hyperalgesia and was associated with an increase in lumbar dorsal horn c-fos expression. Changes in the descending noradrenergic modulation of bilateral heat hypersensitivity mediated by AD- versus C-heat nociceptors was then explored in anaesthetised rats. These experiments further suggested a functional deficit in noradrenergic control, opposed to uz -AR desensitisation, which contributes to the onset of neuropathic ipsilateral hypersensitivity. Further investigations involved pharmacologically restoring descending noradrenergic tone and observing the effects on the development of the neuropathic pain phenotype. It was shown that chronic intrathecal dosing with reboxetine (a selective noradrenaline re-uptake inhibitor) from the time of nerve injury could suppress the onset of allodynia. In addition, the effects of intrathecal versus systemic administration of reboxetine for alleviating spontaneous and evoked neuropathic pain behaviours were also examined, alongside a discussion of the potential clinical implications.
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SORBA, FRANCOIS. "Analgesie peridurale controlee par la patiente au cours du travail : comparaison a l'administration continue". Lille 2, 1993. http://www.theses.fr/1993LIL2M336.
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Vargas, Pacheco Vladimir y López José Fernando Fernández. "ANALGESIA PREVENTIVA: USO DE DEXTROMETORFANO VIA ORAL E INFILTRACION CON LIDOCAINA SIMPLE PARA CONTROL DE DOLOR POSTOPERATORIO EN PACIENTES SOMETIDOS A CIRUGIA ABDOMINAL". Tesis de Licenciatura, Medicina-Quimica, 2013. http://ri.uaemex.mx/handle/20.500.11799/14385.
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El presente trabajo fue de realizado en el Hospital de la Cruz Roja
Mexicana desde el 1 de marzo de 2010 hasta el 30 de agosto de 2010, con un
universo, reflejado en el paciente quirúrgicos con ASAI-ASAII, con una muestra
de 32 pacientes para cirugía de abdomen. Se dividieron en dos grupos: En el
grupo I (Grupo Control) con 16 pacientes y en el grupo II con 16 pacientes.
La analgesia en el posquirúrgico se valoro con dos escalas de dolor las cuales
destacaron en el lapso de 24 horas en diferentes horas al ingreso a la sala de
recuperación y luego a las 4, 8,16 y 24 horas. En el lapso de 24 horas El grupo 2
alcanzo EVA 6 en un 37.5% y el grupo 1 manejo hasta EVA 3 en un 31.25%. La
desviación estándar en el grupo 1 alcanzo 0.23 y el grupo 2 alcanzo 5, en un
punto crítico.
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Benitez, Marian E. "Clinical efficacy and pharmacokinetics of hydrocodone/acetaminophen and tramadol for control of postoperative pain in dogs". Thesis, Kansas State University, 2014. http://hdl.handle.net/2097/17913.
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Master of ScienceDepartment of Clinical Sciences
James K. Roush
Hydrocodone and tramadol are opioid analgesics. No studies have been performed to evaluate the clinical efficacy or pharmacokinetics of hydrocodone/acetaminophen and tramadol in a heterogenous population of dogs. The efficacy of tramadol in dogs has been questioned based on previous pharmacokinetic data. The objectives of this study were to evaluate the analgesic effects of hydrocodone/acetaminophen and tramadol measured by a success/failure model and to determine the pharmacokinetic profile of each drug following the second oral drug dose administration. Fifty client-owned dogs presenting for routine tibial plateau leveling osteotomy were randomized to receive either oral hydrocodone/acetaminophen or tramadol in the postoperative period. A blinded investigator using a modified Glasgow Composite Measure Pain Scale scored each animal. Treatment failures were recorded and compared statistically for differences between the two groups. Blood sampling for pharmacokinetic analysis was initiated after the second oral dose. Mean [plus or minus] SE dose of hydrocodone/acetaminophen administered was 0.5 [plus or minus] 0.04 mg/kg and 16.6 [plus or minus] 1.41 mg/kg for hydrocodone and acetaminophen, respectively. Mean [plus or minus] SE dose of tramadol administered was 5.91[plus or minus] 0.61 mg/kg. The terminal half life, maximal serum concentration (Cmax) and time to maximal serum concentration (Tmax) for tramadol were approximately 1.56 hours, 155.6 ng/mL and 3.90 hours, respectively. Plasma concentrations of the active metabolite O-desmethyltramadol (M1) were low. For hydrocodone, the Cmax and Tmax were approximately 7.90 ng/mL and 3.47 hours, respectively. Plasma concentrations of hydromorphone were low after oral hydrocodone administration. Eighteen of 48 (37.5%) dogs required additional rescue analgesic therapy. This included 10 dogs in hydrocodone group and 8 dogs in the tramadol group (p=0.628). In a group of postoperative patients, no difference in pain scoring could be detected in hydrocodone/acetaminophen and tramadol groups. The pharmacokinetics of tramadol and metabolites were similar to previous studies. Wide variations existed in tramadol drug concentrations and the effects of tramadol are likely independent of the μ-opioid receptor. There is poor metabolism of hydrocodone to hydromorphone in dogs, however, efficacy may be achieved through hydrocodone. The analgesic efficacy of tramadol, 5-7 mg/kg PO q 8 h, and hydrocodone, 0.5 mg/kg PO q 8 h, should be assessed further prior to widespread use in canine postoperative patients.