Resumo Objetivo Avaliar o emplastro de lidocaína 5% como método de tratamento da dor neuropática após cirurgias ortopédicas em comparação com massagem terapêutica realizada sobre incisões. Métodos Trata-se de um ensaio clínico prospectivo, randomizado, com 37 pacientes submetidos a cirurgia ortopédica entre janeiro de 2015 e fevereiro de 2017. Foram incluídos pacientes com idade entre 13 e 70 anos que foram submetidos a cirurgia ortopédica no pé e tornozelo com dor neuropática ou hipersensibilidade na incisão cirúrgica por no mínimo 90 dias após o procedimento. Todos os indivíduos foram avaliados segundo a escala visual analógica (EVA) de dor e o questionário de qualidade de vida SF-36 no início do tratamento e após 30, 60 e 90 dias. Resultados Os dois grupos apresentaram melhora da dor; porém, o grupo que utilizou o emplastro apresentou maior redução com o passar do tempo. Em relação aos parâmetros do questionário SF-36, nenhum deles demonstrou diferença estatisticamente relevante. Em relação à capacidade funcional, aos aspectos físicos, à vitalidade, aos aspectos emocionais, aos aspectos sociais, ao estado geral de saúde e saúde mental, não houve evidências significativas. A grande vantagem do emplastro está no grau de satisfação pessoal dos pacientes, com relevância estatística, provavelmente pela facilidade de aplicação e pelo efeito psicológico de uma terapia medicamentosa. Conclusão O emplastro e a massagem são métodos de tratamento eficazes na redução da dor cicatricial, apresentando resultados semelhantes. O emplastro está associado à melhora do grau de satisfação dos pacientes. Nível de Evidência 1. Ensaio clínico prospectivo randomizado.
Introduction: Chronic postoperative pain, defined as persistent pain at the surgical incision site 3 months after a procedure, is a common complaint in orthopedic practice. Almost 50% of patients who undergo orthopedic surgery are presumably affected by this complaint. The objective of this study is to evaluate the lidocaine patch 5% as a method for neuropathic pain treatment after orthopedic surgery compared with therapeutic massage performed over the incisions. Methods: This is a prospective, randomized clinical trial of 37 patients who underwent orthopedic surgery from January 2015 to February 2017. All individuals were assessed using the pain visual analog scale (VAS) and the 36-Item Short Form Survey (SF-36) quality of life questionnaire at treatment onset and at 30, 60 and 90 days of treatment. Results: Both groups showed improvement in pain, although the group using the patch showed a greater reduction of pain over time. There were no significant differences in the parameters assessed by the SF-36: physical functioning, physical role functioning, vitality, emotional role functioning, social role functioning, general health perceptions or mental health. The main advantage of the patch lay in the degree of patient satisfaction, which was significantly higher than that of massage, most likely because the patch is easily applied and generates a psychological effect as a drug therapy. Conclusion: The lidocaine patch and massage are effective treatment methods for reducing scar pain that show similar results. The patch is associated with an improvement in the degree of patient satisfaction.
Introduction: Patients with lower extremity fractures have a high incidence of peri- and postoperative complications, such as extensive swelling, blisters, surgical wound infection, slow wound healing, persistent wound drainage and suture dehiscence. In calcaneal and tibial plafond fractures and ankle fractures/dislocations, especially in patients older than 50 years and those with diabetes, these complications are associated with a longer hospital stay and increased treatment costs and morbidity and mortality rates. The objective of this study is to perform a literature review of the management of blisters in lower extremity fractures and, based on the findings, to develop a management protocol for these lesions. Methods: Literature review of the state of the art in international databases. Articles published in indexed journals from 1995 to 2014 addressing soft-tissue management in ankle, calcaneal and tibial plafond fractures were selected. Results: Various treatment methods have been described in the literature: observation without intervention, application of sterile dressing, content aspiration, removal of the blister roof and application of an antibiotic ointment or topical treatment alone; all have similar outcomes regarding the delay in definitive surgery and the incidence of mild and severe soft-tissue complications. No large studies comparing these treatment alternatives are available. Conclusion: There is no consensus in the literature on the proper management of blisters. Further studies should be performed to define a protocol for the management of these lesions.
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