1
|
do Nascimento Freitas DW, Dibai-Filho AV, Pontes-Silva A, Araujo GGC, de Oliveira AR, da Cunha Leal P, Gabel CP, Fidelis-de-Paula-Gomes CA, Cabido CET. Translation, cross-cultural adaptation, and validation of the 10-item spine functional index (SFI-10) in the Brazilians with musculoskeletal spine disorders. BMC Musculoskelet Disord 2024; 25:266. [PMID: 38575902 PMCID: PMC10996142 DOI: 10.1186/s12891-024-07406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To translate and cross-culturally adapt the Spine Functional Index (SFI) into Brazilian Portuguese (SFI-Br) in individuals with musculoskeletal spine disorders. METHODS Participants (n=194) answered the Numerical Pain Rating Scale (NPRS), 36-item Short-Form Health Survey (SF-36), Roland-Morris Disability Questionnaire for General Pain (RMDQ-g), and SFI-25 incorporating the SFI-10. Structural validity, from confirmatory factor analysis (CFA), used comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). The best structure was considered from the lower values of the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Construct and criterion validity used Spearman's correlation coefficient (rho). Internal consistency used Cronbach's alpha, reliability used intraclass correlation coefficient (ICC2,1), with ceiling and floor effects determined. Error used the standard error of the measurement (SEM) and minimal detectable change, 90% level (MDC90). RESULTS Adequate fit indices demonstrated an unequivocal one-factor structure only for the SFI-10 (chi-square/DF <3.00, CFI and TLI >0.90, RMSEA <0.08). The SFI-10-Br correlation was high with the SFI-Br (rho=0.914, p<0.001), moderate for the RMDQ-g (rho=-0.78), SF-36 functional capacity domain (rho=0.718) and NPRS (rho=-0.526); and adequate for the remaining SF-36 domains (rho>0.30). Test-retest reliability (ICC2,1=0.826) and internal consistency (alpha=0.864) were high. No ceiling or floor effects were observed, and error was satisfactory (SEM=9.08%, MDC90=25.15%). CONCLUSION The SFI Brazilian version was successfully produced with the 10-item version showing an unequivocal one-factor structure, high construct and criterion validity, reliability, internal consistency, and satisfactory error. Further research on responsiveness is required.
Collapse
Affiliation(s)
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | | | | | - Plinio da Cunha Leal
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, MA, Brazil
| | | | | | | |
Collapse
|
2
|
Mendes LP, Fidelis-de-Paula-Gomes CA, Pontes-Silva A, Barreto FS, Pinheiro JS, da Silva ACB, de Oliveira Pires F, da Cunha Leal P, Avila MA, Dibai-Filho AV. Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population. BMC Musculoskelet Disord 2024; 25:151. [PMID: 38368337 PMCID: PMC10874046 DOI: 10.1186/s12891-024-07268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. METHODS We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects. RESULTS The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. CONCLUSION The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.
Collapse
Affiliation(s)
| | | | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil.
| | - Felipe Souza Barreto
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Sarah Network of Rehabilitation Hospitals, São Luís, Brazil
| | - Jocassia Silva Pinheiro
- Postgraduate in Rehabilitation and Functional Performance, Faculdade de Medicina de Ribeirão Preto, Universidade São Paulo, Ribeirão Preto, Brazil
| | | | - Flávio de Oliveira Pires
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
| | - Plinio da Cunha Leal
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
| | - Mariana Arias Avila
- Postgraduate Program in Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
- Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Brazil
| |
Collapse
|
3
|
Rodrigues RS, Sakata RK, da Silva WV, Raimundo CR, Cerqueira CF, Leal PDC. Exploring the analgesic effects of pregabalin for post-chikungunya arthralgia: a comparative double-blind study. Braz J Anesthesiol 2024; 74:744463. [PMID: 37717925 PMCID: PMC10877331 DOI: 10.1016/j.bjane.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
|
4
|
Lira LLF, Cavalcante KC, Freire TT, Takagi IM, de Oliveira CMB, Moura ECR, Leal PDC. Intraoperative, sociodemographic, and postoperative parameters in individuals undergoing bariatric surgery. Rev Assoc Med Bras (1992) 2023; 69:e20230535. [PMID: 37909617 PMCID: PMC10610775 DOI: 10.1590/1806-9282.20230535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to comparatively analyze sociodemographic data and postoperative parameters of patients undergoing bypass and sleeve surgeries in a private hospital in São Luís, MA. METHODS The study was descriptive, prospective, observational, and comparative, with a quantitative approach between August 2020 and July 2021. We analyzed 74 participants of both genders, aged between 18 and 70 years, with 31 undergoing Roux-en-Y gastric bypass surgery and 43 undergoing sleeve gastrectomy surgery. In the postoperative period, sociodemographic characteristics, surgery and anesthesia duration, pain levels, adverse effects, weight loss, and complications from the surgical procedure were analyzed. RESULTS Males predominated in Roux-en-Y gastric bypass and females in sleeve gastrectomy surgery. Clinical characteristics regarding self-declared ethnicity, age and place of birth, education, and marital status were similar between the studied groups. Roux-en-Y gastric bypass had an average surgery time of 112.14±10.06 min and sleeve gastrectomy 91.11±23.69 min, with a significant difference (p<0.001). Regarding anesthesia time, gastric bypass averaged 160.36±13.99 min and sleeve gastrectomy 154.88±29.10 min, with no statistical difference between groups (p=0.335). Nausea, vomiting, and drowsiness were more common in Sleeve gastrectomy, with no significant difference (p=0.562). Roux-en-Y gastric bypass showed a higher rate of weight loss from 1 month after surgery (14.2±4.15) and more variation in body mass index within 3 months after surgery (32.17±4.76). Complications occurred in a small number of patients. CONCLUSION The two surgical techniques proved effective in delivering the best results for patients, with the group undergoing bypass showing statistically significant weight loss from 1 month after the surgical procedure.
Collapse
Affiliation(s)
- Lyrian Lorena Freire Lira
- Universidade Federal do Maranhão, Postgraduate Program in Physical Education – São Luís (MA), Brazil
| | | | | | | | | | - Ed Carlos Rey Moura
- Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil
| | - Plinio da Cunha Leal
- Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil
| |
Collapse
|
5
|
Pereira Pires JA, Rey Moura EC, de Oliveira CMB, Vieira Dibai-Filho A, Soares Brandão Nascimento MDD, da Cunha Leal P. Hypertonic glucose in the treatment of low back pain: A randomized clinical trial. Medicine (Baltimore) 2023; 102:e35163. [PMID: 37747016 PMCID: PMC10519545 DOI: 10.1097/md.0000000000035163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Chronic low back pain (LBP) is defined as pain lasting longer than 3 months and is one of the conditions with the most significant social impact. Treatment is complex and includes proliferative agents used in prolotherapy. The mechanism is not known, but osmotic agents (hypertonic solutions of dextrose or glucose) cause cellular rupture and an inflammatory response that releases cytokines and growth factors that lead to scarring and reinnervation. METHODS Patients with chronic LBP (>12 weeks) who were non-traumatic and unresponsive to at least 1 month of physical therapy were selected. All patients were followed up at a return visit at 1, 3, and 6 months for pain assessment using validated pain questionnaires and scales. RESULTS Nineteen patients were included in the conservative group and 19 in the glucose group, with the majority being women (57.9%). The patients were between 47 and 59 years of age (39.5%), mixed race (76.33%), married or in a committed relationship (73.7%), and had completed the study for 5.2 years. Overall mean body mass index was 27.3 ± 4.4 kg/m 2 and was higher in the conservative group (28.0 ± 4.7 kg/m 2 ). The groups showed differences in Visual Analog Scale scores, with median and amplitude values close to each other between the time points evaluated and increasing values in the glucose group, which had significantly higher values for this scale at the third evaluation ( P = .031). When comparing the Rolland-Morris scale scores between the groups, there was a significant difference only in the 3-m assessment ( P = .021). In the follow-up assessment, both groups showed significant improvement between T0 and the other assessment time points ( P < .05) in all evaluations. CONCLUSION Both groups significantly improved on the evaluated scales during follow-up. Overall, no effects were attributable to the glucose components or the prolotherapy protocol.
Collapse
Affiliation(s)
- Jose Alberto Pereira Pires
- Department of Neuro-Orthopedics, University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Ed Carlos Rey Moura
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Plinio da Cunha Leal
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
| |
Collapse
|
6
|
Nogueira J, Melo VG, Lima LCS, Costa MVLR, Silva LC, Gomes LMRDS, Freire GIDM, Leal PDC, de Oliveira CMB, Moura ECR. Improved quality of life (EHP-30) in patients with endometriosis after surgical treatment. Rev Assoc Med Bras (1992) 2023; 69:e20230316. [PMID: 37585993 PMCID: PMC10427168 DOI: 10.1590/1806-9282.20230316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/21/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study aimed to evaluate the quality of life of patients with endometriosis before and after surgical treatment. METHODS An observational, longitudinal, and prospective study was conducted with 102 women with pelvic pain and endometriosis that was unimproved by clinical treatment and indicated for surgical treatment. The patients' quality of life was assessed using the 30-item Endometriosis Health Profile (EHP-30) questionnaire before and 3 and 6 months after surgery. The statistical tests were analyzed using the Statistical Package for Social Sciences version 17.0, and the Friedman test was used. RESULTS There was a reduction in EHP-30 scores 3 and 6 months after surgery compared to before surgery, as well as 6 months after surgery compared to 3 months after surgery, in the central questionnaire (PART 1) and in Sections A, B, C, E, and F (p<0.0001). For Section D, there was a reduction in scores 6 months after surgery compared to before surgery (p<0.0001). CONCLUSION Surgical treatment of endometriosis improves quality of life in several areas assessed by the EHP-30 questionnaire.
Collapse
Affiliation(s)
- João Nogueira
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Vinicius Gonçalves Melo
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | - Luna Carolina Silva Lima
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | | | - Leonardo Carvalho Silva
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
| | - Lyvia Maria Rodrigues de Sousa Gomes
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | | | - Plinio da Cunha Leal
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Caio Marcio Barros de Oliveira
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| | - Ed Carlos Rey Moura
- Universidade Federal do Maranhão, College of Medicine, Department of Medicine – São Luís (MA), Brazil
- Hospital São Domingos, Ginecology Service – São Luís (MA), Brazil
| |
Collapse
|
7
|
Viana LBDR, Oliveira EJSGD, Oliveira CMBD, Moura ECR, Viana LHL, Nina VJDS, Farkas E, Leal PDC. Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study. Rev Assoc Med Bras (1992) 2023; 69:473-478. [PMID: 36820781 PMCID: PMC10004288 DOI: 10.1590/1806-9282.20221655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. METHODS A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. RESULTS Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. CONCLUSION Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Emily Farkas
- Roudebush VA Medical Center, Division of Cardiothoracic Surgery - Indianapolis (IN), United States
| | | |
Collapse
|
8
|
Vinent PMS, Oliveira EJSGD, Oliveira CMBD, Moura ECR, Servin ETN, Gomes LMRDS, Leal PDC. Ultrasound-guided popliteal sciatic nerve block in a pediatric patient with complex regional pain syndrome: a case report. Braz J Anesthesiol 2021:S0104-0014(21)00293-1. [PMID: 34324935 DOI: 10.1016/j.bjane.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/24/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022]
Abstract
In the pediatric population, complex regional pain syndrome (CRPS) is a challenging condition that leads to chronic psychosocial dysfunction. This case is of a 12-year-old male patient, 50 kg, who, after twisting his right ankle, started to present intense pain. Without adequate diagnosis and treatment, his family sought a pain specialist. During the evaluation, a change in sensitivity and temperature was observed, besides hyperalgesia, allodynia, redness, edema, and motor dysfunction, being diagnosed with CRPS. Ultrasound-guided sciatic blocks were performed on the affected limb, increasing the interval between crises, reducing pain intensity, and promoting a return to daily activities.
Collapse
|
9
|
Nogueira Neto J, Carmo ADOD, Lima LSC, Gomes LMRDS, Moura ECR, Oliveira CMBD, Raymundo TS, Melo GCFD, Leal PDC. Use of hypertonic glucose (10%) in the prevention of postoperative adhesions in rats. Acta Cir Bras 2021; 36:e360504. [PMID: 34190774 PMCID: PMC8232060 DOI: 10.1590/acb360504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of hypertonic glucose (10%), alone or in combination
with the corticoid dexamethasone, to prevent peritoneal adhesion following
hysterectomy in rats. Methods Forty-two adult rats underwent hysterectomy with peritoneal lavage: G1 –
glucose (10%); G2 – glucose (10%) and dexamethasone 3 mg·kg–1;
and G3 – physiological saline (PS) 0.9%. Results In the macroscopic analysis after 14 days, G1 had a median score of 1, G2 of
1, and G3 of 2.5 (p < 0.0001), G3 compared to G1 and G2. There was no
difference between groups after 28 days. In the microscopic analysis, the
median vascular proliferation after 14 days was 2 for G1, 1 for G2, and 3
for G3 (p = 0.0037, G3 vs. G1 and G2). After 28 days, G1 showed a median
vascular proliferation score of 2, G2 of 2.5, and G3 of 3 (p < 0.0001, G3
vs. G1 and G2). Regarding the inflammatory reaction after 14 days, G1 had a
median score of 2, G2 of 1, and G3 of 3 (p = 0.7916). After 28 days, G1 had
a median score of 0.5 (0–1.75), G2 of 1.5, and G3 of 2.5 (p < 0.0001, G3
vs. the others and G2 vs. G1). In the evaluation of fibrosis after 14 days,
G1 had a median score of 1, G2 of 1, and G3 of 2.5 (p < 0.0001, G3 vs.
G1and G2). After 28 days, G1 had a median fibrosis score of 1, G2: 2, and
G3: 2.5 (p < 0.0001), G3 vs. the others andG2 vs. G1). Conclusions The use of hypertonic glucose (10%) solution seems to reduce macroscopic and
microscopic pelvic adhesions.
Collapse
|
10
|
Leal PDC, Lima WL, Oliveira EJSGD, Oliveira CMBD, Gomes LMRDS, Servin ETN, Moura ECR. Combined spinal-epidural anesthesia for abdominoplasty and liposuction in Limb-Girdle Muscular Dystrophy: case report. Braz J Anesthesiol 2021; 71:299-301. [PMID: 33823207 PMCID: PMC9373207 DOI: 10.1016/j.bjane.2021.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/14/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022] Open
Abstract
We report the anesthetic management with combined spinal-epidural in a patient with limb-girdle muscular dystrophy type 2A, submitted to abdominoplasty and liposuction. The patient had onset of symptoms at 8 years old, diagnosed by muscular biopsy, presenting muscle weakness in the scapular and pelvic girdles, with reduced mobility. We performed monitorization with noninvasive blood pressure, oximeter, thermometer, and electrocardiogram. In the postoperative period, she showed no clinical signs of rhabdomyolysis, myotonia, or adverse effects, maintaining hemodynamic stability. The anesthesia technique allowed spontaneous ventilation, monitoring of clinical parameters close to physiological conditions and used smaller doses of medication, reducing related risks.
Collapse
|
11
|
Lima RCD, Rodrigues TMDS, Scheibe CL, Campelo GP, Pinto LEV, Valadão GJC, Carvalho GPCD, Machado Junior MRD, Valadão JA, Lima PCRD, Leal PDC, Oliveira CMBD, Moura ECR. Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment. Acta Cir Bras 2021; 36:e360203. [PMID: 33624720 PMCID: PMC7902054 DOI: 10.1590/acb360203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of
obese patients, adherence to clinical follow-up and the influence of factors
such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with
patients undergoing vertical gastrectomy, operated at Hospital São Domingos,
between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%)
and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was
56.18%. Among adherent patients (n = 117; 43.82%), most patients were female
(n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body
mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72
kg/m2. Both BMI and excess weight (EW) showed a statistically
significant difference between pre- and postoperative period. Percentage of
excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients.
Older patients had a statistically significant lower % EWL compared to the
other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with
significant weight loss.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Plinio da Cunha Leal
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
| | | | - Ed Carlos Rey Moura
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
| |
Collapse
|
12
|
Sampaio MAF, Sampaio SLP, Leal PDC, Moura ECR, Alvares LGGS, DE-Oliveira CMB, Torres OJM, Martins MDG. ACERTO PROJECT: IMPACT ON ASSISTANCE OF A PUBLIC EMERGENCY HOSPITAL. ACTA ACUST UNITED AC 2021; 33:e1544. [PMID: 33470374 PMCID: PMC7812687 DOI: 10.1590/0102-672020200003e1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
Background: In Brazil, the goal-based approach was named Project ACERTO and has obtained
good results when applied in elective surgeries with shorter hospitalization
time, earlier return to activities without increased morbidity and
mortality. Aim: To analyze the impact of ACERTO on emergency surgery care. Methods: An intervention study was performed at a trauma hospital. Were compared 452
patients undergoing emergency surgery and followed up by the general surgery
service from October to December 2018 (pre-ACERTO, n=243) and from March to
June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused
postoperative venous hydration, duration of use of catheters, probes and
drains, postoperative analgesia, prevention of postoperative vomiting, early
mobilization and physiotherapy were evaluated. Results: After the ACERTO implantation there was earlier reintroduction of the diet,
the earlier optimal caloric intake, earlier venous hydration withdrawal,
higher postoperative analgesia prescription, postoperative vomiting
prophylaxis and higher physiotherapy and mobilization prescription were
achieved early in all (p<0.01); in the multivariate analysis there was no
change in the complication rates observed before and after ACERTO (10.7% vs.
7.7% (p=0.268) and there was a decrease in the length of hospitalization
after ACERTO (8,5 vs. 6,1 dias (p=0.008). Conclusion: The implementation of the ACERTO project decreased the length of hospital
stay, improved medical care provided without increasing the rates of
complications evaluated.
Collapse
Affiliation(s)
| | | | - Plinio da Cunha Leal
- Postgraduate Program in Adult Health, Federal University of Maranhão, São Luís, MA, Brazil
| | - Ed Carlos Rey Moura
- Postgraduate Program in Adult Health, Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | | | | |
Collapse
|
13
|
Rey Moura EC, de Oliveira CMB, da Cunha Leal P, Kimiko Sakata R. Minimum Effective Analgesic Concentration of Ropivacaine in Saphenous Block Guided by Ultrasound for Knee Arthroscopic Meniscectomy: Randomized, Double-Blind Study. J Pain Res 2021; 14:53-59. [PMID: 33469356 PMCID: PMC7812526 DOI: 10.2147/jpr.s282286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background After knee surgery, analgesia should be effective for mobilization and discharge. Aim of the Study The primary objective of this study was to achieve the lowest effective analgesic concentration (MEC50 and MEC90) of ropivacaine for saphenous nerve block in arthroscopic meniscectomy. The secondary objective was to determine whether the block causes muscle weakness in the postoperative period. Methods The study was randomized, comparative, and double-blind. Fifty-one patients between 18 and 65 years old of both sexes, ASA I or II, who underwent knee arthroscopic meniscectomy at São Domingos Hospital were included. Patients underwent saphenous nerve block with 10 mL of ropivacaine administered by using the up-and-down method. The ropivacaine concentration was determined based on the previous patient’s response (a biased-coin up-down design sequential method). If a patient had a negative response, the concentration of ropivacaine was increased by 0.05% in the next patient; if the response was positive, the next patient was randomized to be administered the same concentration of ropivacaine or a 0.05% lower concentration. Successful block was defined as pain <4 during 6 h. Patients underwent general anesthesia with 30 µg/kg alfentanil and propofol and maintenance with propofol, and, if necessary, remifentanil was administered. Postoperative analgesia was complemented with dipyrone, and if necessary, tramadol (100 mg) could be used. The following parameters were assessed: the success of the block; pain intensity after 2, 4, and 6 h; the consumption of remifentanil; time to the first analgesic supplementation; percent of patients who needed analgesics during 6h; and muscle strength. Results The MEC50 of ropivacaine was 0.36%, and the MEC90 was 0.477%. The block was successful in 45 patients. Conclusion Saphenous block with 10 mL of 0.36% ropivacaine provides adequate analgesia for outpatient meniscectomy.
Collapse
Affiliation(s)
- Ed Carlos Rey Moura
- Universidade Federal de São Paulo, Department of Anesthesia, São Paulo, Brazil
| | | | - Plinio da Cunha Leal
- Universidade Federal do Maranhão, Department of Medicine, São Luiz, Maranhão, Brazil
| | - Rioko Kimiko Sakata
- Universidade Federal de São Paulo, Department of Anesthesia, São Paulo, Brazil
| |
Collapse
|
14
|
ValadÃo JA, Leal PDC, Oliveira EJSGD, Torres OJM, Pinto LEV, Marchi DDD, Gama-Filho OP, Santo MA, Nassif PAN. VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS? Arq Bras Cir Dig 2020; 33:e1513. [PMID: 32844876 PMCID: PMC7448852 DOI: 10.1590/0102-672020190001e1513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.
Collapse
Affiliation(s)
- José Aparecido ValadÃo
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | | | - Marco Aurelio Santo
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
| |
Collapse
|
15
|
Cossetti Leal RJD, Pereira EC, Ribeiro TS, Machado MLM, de Carvalho RB, Neme LM, Alves DC, Leal PDC, Brito LMO, Chein MBDC. Evaluation of a mobile cervical cancer screening program in São Luis, Maranhão, Brazil: Impact and challenges. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1558 Background: Cervical cancer (CC) still represents a public health priority in Brazil, with estimated incidence of 15,43 cases per 100.000 women. CC is the most frequent cause of cancer and cancer-related mortality in women in the state of Maranhão. The Brazilian national screening program recommends cervical cytology (Pap test) every 3 years in women 25-64 years old. Although of public access, the screening program continues to be non-organized. This was a real-life CC screening intervention through a mobile screening unit (MSU) in communities of São Luis, Maranhão. Methods: Prospective, intervention-based, analytic study, from April to August, 2018. Women in the assisted communities were offered Pap tests. Tests were collected and results were retrieved within 4 weeks along with further screening recommendations. Quality control and monitoring of the test were done. A structured questionnaire was applied. Results: 960 tests were collected and 545 women answered the questionnaire. Median age: 43 (34 – 52), with 88.2% of women within the target age. Socioeconomic charachteristics: 47.3% completed high school education; 37.8% were housewives, 16.1% were unemployed; 56.3% were married; 59.8% had a monthly family-income up to 1 minimum wage ($ 250,00). Previous Pap tests and difficulties: 94.1% had at least one previous test; 78,2% had a test within the past 3 years; 48.4% referred to dificculties to scheduling, 23.3% time constraints, 11.2% being ashamed, and 10.4% financial restrains. There were 65 (6.9%) abnormal results (LSIL in 3%, HSIL in 0.7%, and in situ adenocarcinoma in 1 case), for whom further investigation was recommended. Follow-up was possible in 31 of these cases. More than 50% were still awaiting for additional screening tests at time of contact (>6 month interval). Conclusions: MSU strategy faccilitated the access to Pap tests, their results and recommendations. Although Pap test was easily available, the non-organized process of invitation, follow-up and referal of positive cases for further investigation, as offered by the Brazilian public health services, limit screening efficacy and CC control.
Collapse
|
16
|
Lima RLS, Oliveira EJSGD, Pereira EC, Costa LDS, Dourado TS, Valadão JA, Lima RC, Campelo GP, Brito RMD, Oliveira CMBD, Moura ECR, Leal PDC. Comparative analysis between patients undergoing Gastric Bypass and Sleeve Gastroplasty in a private hospital in Sao Luis-MA. Acta Cir Bras 2020; 35:e202000307. [PMID: 32692798 PMCID: PMC7251972 DOI: 10.1590/s0102-865020200030000007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/01/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. METHODS The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. RESULTS Most patients were female (Bypass - 56% and Sleeve - 67.4%) and aged between 30 and 39 years old (Bypass - 32% and Sleeve - 55.8%). Information (Bypass - 92% and Sleeve - 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass - 92% and Sleeve - 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. CONCLUSIONS Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.
Collapse
|
17
|
Cossetti Leal RJD, Lima TU, Pereira EC, Nascimento RVB, Oliveira EJSG, Oliveira CMB, Moura ECR, Nogueira Neto J, Leal PDC. Effect of music therapy on symptoms, adverse events, and quality of life of breast cancer patients undergoing chemotherapy: A randomized clinical trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24140 Background: Music can influence human behavior and may be used as complementary therapy in health care. Objective: To assess the effect of music therapy on symptoms, adverse events and quality of life (QoL) of breast cancer patients undergoing chemotherapy (CT). Methods: Non-blinded, randomized clinical trial. Patients were randomized into two groups: musical group (MG) or control group (CG), and followed during the first 3 cycles of CT. Sociodemographic data, WHOQOL-BREF, BDI-II, BAI and Chemotherapy Toxicity Scale were assessed. Patients were evaluated after each of the first three CT cycles. MG underwent a 30-minute musical intervention prior to CT. There was no intervention in the CG. Results: Higher QoL scores on functional scales were observed for the MG in comparison to the CG after the first and third sessions of chemotherapy. Depression (p < 0.001) and anxiety scores (p < 0.001) and vomiting (p 0.01) incidence were lower for the MG in the third CT session. All participants in the MG reported positive changes in life in the Subjective Impression of the Subject questionnaire, as well as improvement in fatigue and reduced stress levels. Conclusions: Improvements in QoL, anxiety, depression, and incidence of vomiting were associated with music therapy intervention, suggesting a positive effect of music therapy on adverse events of cancer CT. Clinical trial information: RBR-88r347 .
Collapse
|
18
|
Campelo GP, da Cunha Leal P, de Oliveira CMB, Moura ECR, de Oliveira EJSG, de Lima RC, Valadão JA. Long Biliopancreatic Limb Roux-en-Y Gastric Bypass Revisional Surgery in a Myasthenia Gravis Patient: Case Report. Obes Surg 2020; 30:2800-2801. [PMID: 32124211 DOI: 10.1007/s11695-020-04501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
da Cunha Leal P, Rey Moura EC, Jorge Dino Cossetti R, Ramos do Nascimento J, Portela Bogéa Serra IC, de Paulo Ribeiro B, Álvares Marques Vale A, Silva de Azevedo Dos Santos AP, Fernandes do Nascimento FR, Kimiko Sakata R. High dose gabapentin does not alter tumor growth in mice but reduces arginase activity and increases superoxide dismutase, IL-6 and MCP-1 levels in Ehrlich ascites. BMC Res Notes 2019; 12:59. [PMID: 30683148 PMCID: PMC6347815 DOI: 10.1186/s13104-019-4103-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/19/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the effect of gabapentin on Ehrlich tumor growth in Swiss mice, a highly aggressive and inflammatory tumor model. Mice were grouped into sets of 5 animals and treated from days 2 to 8 with gabapentin 30 mg/kg body weight (G30) or 100 mg/kg body weight (G100), or normal sterile saline (control). Results The mice were euthanized on day 10. Tumor growth, tumoricidal agents and inflammatory cytokines levels were assessed. At day 10, G30 and G100 mice gained weight, but there were no differences in tumor cell count or in ascites volume. In G100, there was a reduction in arginase and an increase in SOD activities. There was an increase in IL-6 and MCP-1 levels, especially in G100, but no alterations in TNF-α. There was no direct evidence of tumor induction by gabapentin. However, the findings suggest that its use modulates immune response to a more effector and less deleterious profile, with increase in activity of anti-oxidant enzymes and in cytokines that favor activation of macrophages, which could improve the general status of the tumor host. Electronic supplementary material The online version of this article (10.1186/s13104-019-4103-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Plinio da Cunha Leal
- Federal University of Maranhão, São Luís, MA, Brazil. .,Rua das Boninas, Bloco 2, apartment 1202, condomínio Ile Saint Louis, São Luís, MA, 65077-552, Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Santiago AEQ, Leal PDC, Moura ECR, Salomão R, Brunialti MKC, Sakata RK. Effect of preoperative pregabalin on analgesia and interleukins after lumbotomy: prospective, randomized, comparative, double-blind study. J Pain Res 2019; 12:339-344. [PMID: 30666152 PMCID: PMC6333154 DOI: 10.2147/jpr.s189441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background Pregabalin is an anticonvulsant and has been used for postoperative analgesia. This study aimed to assess the effect of a single preoperative dose of pregabalin for analgesia after nephrectomy. Methods The study was prospective, randomized, comparative, and double-blinded, conducted in 40 kidney transplant donors, between 18 and 60 years, American Society of Anesthesia physical status I or II. Epidural anesthesia was performed with 15 mL of 0.5% ropivacaine single shot and general anesthesia with 3 µg/kg of fentanyl, propofol, atracurium, and sevoflurane, and 50% of oxygen without nitrous oxide. Patients in group 1 were administered 300 mg of pregabalin and those in group 2 were administered placebo, in identical capsules, 1 hour prior to surgery. Postoperative analgesia was supplemented with tramadol. The following parameters were assessed: pain intensity after 6 and 24 hours; pain threshold, from the thenar and peri-incisional region, analgesic supplementation; ILs (IL6, IL8, and IL10) prior to surgery and after 6 and 24 hours. Results The pain intensity was lower with pregabalin after 24 hours (G1: 2.5±2.4, G2: 3.0±2.6). There was no difference in the sensitivity of the thenar and peri-incisional region after 6 and 24 hours; in the number of patients requiring supplementation (G1=15%, G2=45%); concentrations of IL-6, IL-8, and IL-10; and side effects (nausea, vomiting, dizziness, and pruritus). Conclusion Pregabalin in a single preoperative dose of 300 mg reduced pain intensity 24 hours after lumbotomy.
Collapse
Affiliation(s)
| | | | - Ed Carlos Rey Moura
- Department of Anesthesia, Universidade Federal de São Paulo, São Paulo, Brazil,
| | - Reinaldo Salomão
- Department of Anesthesia, Universidade Federal de São Paulo, São Paulo, Brazil,
| | | | - Rioko Kimiko Sakata
- Department of Anesthesia, Universidade Federal de São Paulo, São Paulo, Brazil,
| |
Collapse
|
21
|
Albertoni Giraldes AL, Salomão R, Leal PDC, Brunialti MKC, Sakata RK. Effect of intravenous lidocaine combined with amitriptyline on pain intensity, clinical manifestations and the concentrations of IL-1, IL-6 and IL-8 in patients with fibromyalgia: A randomized double-blind study. Int J Rheum Dis 2016; 19:946-953. [DOI: 10.1111/1756-185x.12904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Reinaldo Salomão
- Department of Anesthesia; Federal University of São Paulo; São Paulo Brazil
| | | | | | | |
Collapse
|
22
|
Moura ECR, de Oliveira Honda CA, Bringel RCT, Leal PDC, Filho GDJL, Sakata RK. Minimum Effective Concentration of Bupivacaine in Ultrasound-Guided Femoral Nerve Block after Arthroscopic Knee Meniscectomy: A Randomized, Double-Blind, Controlled Trial. Pain Physician 2016; 19:E79-E86. [PMID: 26752495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effects; however, motor block can occur. Ultrasound-guided femoral nerve block may reduce the required local anesthetic concentration, preventing motor block. OBJECTIVE The primary objective of this study was to determine the lowest effective analgesic concentration of bupivacaine in 50% (EC50) and in 90% (EC90) of patients for a successful ultrasound-guided femoral nerve block in arthroscopic knee meniscectomy. STUDY DESIGN This was a prospective, randomized, double-blind, controlled trial. SETTINGS This study was conducted at Hospital São Domingos. METHODS A total of 52 patients undergoing arthroscopic knee meniscectomy were submitted to ultrasound-guided femoral nerve block using 22 mL bupivacaine. The bupivacaine concentration given to a study patient was determined by the response of the previous patient (a biased-coin design up-down sequential method). If the previous patient had a negative response, the bupivacaine concentration was increased by 0.05% for the next case. If the previous patient had a positive response, the next patient was randomized to receive the same bupivacaine concentration (with a probability of 0.89) or to have a decrease by 0.05% (with a probability of 0.11). A successful block was defined by a numerical pain intensity scale score < 4 (0 = no pain; 10 = worst imaginable pain) in 3 different evaluations. If the pain intensity score was = 4 (moderate or severe pain) at any time, the block was considered failed. General anesthesia was induced with 30 µg/kg alfentanil and 2 mg/kg propofol, followed by propofol maintanance, plus remifentanil if needed. Postoperative analgesia supplementation was performed with dipyrone; ketoprofen and tramadol were given if needed. DATA MEASUREMENTS The following parameters were evaluated: numerical pain intensity score, duration of analgesia, supplementary analgesic dose in 24 hours, and need for intraoperative remifentanil. RESULTS The EC50 was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300). There was no difference in numerical pain intensity score for the different concentrations of bupivacaine. A successful block was achieved in 45 patients, with no difference according to bupivacaine concentration. Time to first analgesic supplementation dose was longer for bupivacaine concentrations = 0.3% (543.8 ± 283.8 min.), compared to 0.25% (391.3 ± 177.8 min.) and < 0.25% (302.3 ± 210.1 min.). There were no differences in supplementary analgesic dose in 24 hours nor in the use of intraoperative remifentanil according to bupivacaine concentration. LIMITATIONS The analgesic effect was measured only during the first 2 hours. CONCLUSIONS Bupivacaine EC50 for ultrasound-guided femoral nerve block was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300).
Collapse
|
23
|
Nascimento MDDSB, Souza EC, da Silva LM, Leal PDC, Cantanhede KDL, Bezerra GFDB, Viana GMDC. [Prevalence of infection by Leishmania chagasi using ELISA (rK39 and CRUDE) and the Montenegro skin test in an endemic leishmaniasis area of Maranhão, Brazil]. CAD SAUDE PUBLICA 2006; 21:1801-7. [PMID: 16410865 DOI: 10.1590/s0102-311x2005000600028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A prospective study was undertaken in 1,520 children less than 15 years of age in São José de Ribamar, Maranhão, Brazil, from June 1994 to January 1995, to evaluate the prevalence and characteristics (socioeconomic, environmental, and behavioral) associated with infection by Leishmania chagasi. Montenegro skin test (MST) and enzyme-linked immunosorbent assay (ELISA-rK39 and CRUDE) test were used to detect infection. The statistical analysis used the chi2 test with Yates correction and a p value less than 0.05 was considered statistically significant. Prevalence of infection was 61.7% as measured by MST, 19.4% according to ELISA (rK39), and 19.7% by ELISA (CRUDE). Association was detected between leishmaniasis in the family, water supply, application of insecticide, and infection by L. chagasi using MST. No association with infection by L. chagasi was detected using ELISA rK39 or CRUDE. More effective control measures are needed to reduce prevalence and to detect asymptomatic cases in this high percentage of infected children.
Collapse
|