Objetivo: Comparar a eficácia de diferentes corticosteroides (dexametasona, betametasona e triancinolona) utilizados na técnica de bloqueio do ramo troncular, por meio da avaliação da melhora do quadro álgico, em pacientes com lombociatalgia. Métodos: 60 pacientes maiores de 18 anos, com queixa de lombociatalgia refratária ao tratamento conservador, diagnosticados com hérnia de disco lombar foraminal extrusa por meio do exame de ressonância magnética, sem critérios de instabilidade vertebral em radiografias dinâmicas da coluna lombar foram divididos em 3 grupos de 20 indivíduos cada. O Grupo 1 recebeu dexametasona, o Grupo 2 betametasona e o Grupo 3 triancinolona. Todos os pacientes responderam à escala visual analógica nos períodos de pré-bloqueio e com 1, 6 e 12 meses após a realização do mesmo para avaliação de dor. Resultados: Foi observado melhora significativa da dor após a realização do bloqueio nos 3 grupos, não havendo diferença estatística entre os fármacos. Conclusão: O bloqueio do ramo troncular é uma técnica eficaz no tratamento das lombociatalgias, contudo, não existe diferença na eficácia dos três fármacos estudados. Sendo assim, a escolha do corticosteroide deve ser feita de forma individualizada, levando-se em conta fatores não avaliados nesse estudo, como disponibilidade, custo e reações adversas.
Objective: To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication. Method: Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery. Results: There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA. Conclusion: This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.
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