Estudo comparativo de duas diferentes modalidades de analgesia controlada pelo paciente após cirurgia cardíacaComparasion study of two different patientcontrolled anesthesia regiments after heart surgery Abstract Introduction: Acute and severe pain is frequent in patients who undergo heart surgery and patient controlled analgesia (PCA) can be used to manage postoperative pain.Objective: To compare analgesia using PCA without continous infusion with PCA plus a continuous infusion of morphine on postoperative period of heart surgery and to assess pain scores, morphine consumption, number of demand, patient satisfaction and side effects.Methods: Randomized clinical trial was performed to assess patients who had undergone heart surgery who received either PCA with and without intravenous infusion of morphine. In the postoperative period, PCA was started at extubation in both regiments according to randomization. Pain intensity, morphine consumption, number of demand, satisfaction and side effects were assessed at zero, six, twelve, eighteen, twenty four and thirty hours after patients' extubation.Results: The study enrolled 100 patients. 50 patients received PCA without continuous infusion of morphine (Group A), and 50 patients received morphine PCA plus a continuous infusion of morphine (Group B). Group B patients had less demand of morphine, consumed more morphine and were more satisfied regarding analgesia. No statistical differences were found between groups related to pain intensity, and side effects.Conclusions: Pain control was effective and similar in both groups. The same efficacy of analgesia and the less morphine consumption suggest that PCA without continuous infusion of morphine seems to be better option for postoperative pain manage in heart surgery.
Descriptors
39MOTA, FA ET AL-Comparasion study of two different patientcontrolled anesthesia regiments after heart surgery Rev Bras Cir Cardiovasc 2010; 25(1): 38-44 less side effects and drug consumption after cardiac surgery. Thus, this randomized controlled study was carried out with the aim to compare these two regiments after cardiac surgery.
METHODSThe study protocol was approved by the institutional ethical and research committee and patients were enrolled in the study after formal consent. The major eligibility criteria are listed in Table 1.
Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15 th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30 th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy.Descriptors: Laser therapy, low-level. Surgical wound dehiscence. Wound healing.
ResumoDeiscência é uma complicação temida em cirurgias de grande porte. Paciente submetida a revascularização miocárdica evoluiu com deiscência de safenectomia em membro inferior, edema e dor no 15º dia pós-operatório (PO), tendo sido realizado inicialmente o tratamento convencional no ambulatório sem melhora clínica. No 30º PO, aplicou-se somente Laser de Baixa Intensidade (LBI) ao redor da borda da ferida, pontualmente. A lesão respondeu com tecido de granulação, diminuição do processo inflamatório e analgesia desde a primeira aplicação. Neste estudo piloto, a laserterapia mostrou ter um papel importante como agente facilitador de cicatrização, por meio de uma terapia não-invasiva, eficaz e segura.Descritores: Terapia a laser de baixa intensidade. Deiscência da ferida operatória. Cicatrização de feridas.
BACKGROUND AND OBJECTIVES:Post-herpetic neuralgia (PHN) is the pain remaining after the resolution of acute herpes zoster episode. This study aimed at reporting a case of PHN pain treatment in lung transplanted patient.
CASE REPORT:Male patient, 73 years old, submitted to lung transplantation three years ago and under immunosuppressants. He developed herpes zoster one year ago with vesicles in the eighth intercostal space of the right hemithorax (RHT). Treatment was effective with ganciclovir, however the patient evolved with severe, constant burning pain worsened one month ago with intensity 9 according to the numeric visual scale (NVS), even with 600 mg/day gabapentin. At physical evaluation he presented a hyperesthesic reddish lesion in the RHT. Patient was treated with gabapentin (900 mg), amitriptyline (25 mg), dipirone (8 g) and oxycodone (20 mg) per day. Low intensity laser (LIL) was applied daily for one week, followed by treatment with 4% topic amitriptyline. Pain intensity decreased to 5.
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