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Introduction: Neuropathic pain (NP) is characterised as a lesion or disease directly affecting the somatosensory system. This study aims to analyse the efficacy of botulinum toxin type A (BT-A) in the treatment of neuropathic pain. Methods: This systematic literature review, guided by PRISMA, applied the PICO strategy with the following criteria: (P = patients with neuropathic pain, I = botulinum toxin, C = placebo or active drug, and O = pain relief). Results: Fourteen articles, all randomised controlled trials with a placebo control, were included in the review. A total of 645 patients were randomised, with 353 patients receiving treatment with botulinum toxin type A in doses ranging from 25U to 400U. The evaluated studies addressed trigeminal neuralgia, diabetic polyneuropathy, post-herpetic neuralgia, spinal cord injury, phantom limb pain, and peripheral neuropathic pain after trauma or surgery. Conclusion: BT-A has emerged as a promising treatment for various origins of neuropathic pain. Therefore, future studies should adopt stricter criteria regarding dosage and routes of administration to ensure effective and consistent BT-A application.
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Aim: This study reassesses the efficacy and safety of antidepressants in treating nonspecific chronic low back pain (NCLBP).Materials & methods: A systematic review was conducted following PRISMA guidelines, including randomized clinical trials (RCTs) from PubMed, Embase, Scopus, LILACS, SciELO and Cochrane CENTRAL, published through August 2024. Studies compared antidepressants with placebo or active comparators. The primary outcomes were pain relief and quality of life. Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023307516.Results: Nine RCTs involving 1758 patients were analyzed. The antidepressants examined included duloxetine, escitalopram, bupropion, amitriptyline, imipramine and desipramine. Duloxetine 60 mg significantly reduced pain (MD = -0.57; 95% CI = -0.78 to -0.36) and improved quality of life compared with placebo, with side effects that were generally tolerable. Notably, higher doses of duloxetine (120 mg) were associated with an increase in adverse events. However, other antidepressants like amitriptyline and escitalopram demonstrated only modest or inconsistent effects.Conclusion: Duloxetine at 60 mg provides consistent pain relief and improves the quality of life in NCLBP, but higher doses increase adverse events. Escitalopram might offer modest benefits but should be considered a third-line treatment. Other antidepressants, such as amitriptyline, bupropion, imipramine and desipramine, have limited evidence supporting their efficacy and are associated with adverse effects.
Chronic lower back pain is a condition that persists for a long time and can be difficult to manage. While the exact cause isn't always clear, it affects many people and can be difficult to manage. Doctors sometimes prescribe antidepressants, which are typically used for treating depression, but they may also help to reduce pain by influencing how the brain processes it.In this paper, we examined several studies to determine whether these antidepressants are effective in treating chronic lower back pain. We analyzed nine studies involving 1758 participants who were treated with different medications: bupropion, duloxetine, escitalopram, amitriptyline, imipramine and desipramine.Among these medications, duloxetine stood out as the most effective. It not only helped to relieve pain but also improved the participants' ability to carry out daily activities. Additionally, duloxetine had fewer side effects than some of the other medications, although it can still cause mild issues such as nausea.In conclusion, duloxetine appears to be a promising option for managing chronic lower back pain, as long as the appropriate dosage is used to balance pain relief and side effects.
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Antidepresivos , Dolor Crónico , Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Antidepresivos/uso terapéutico , Antidepresivos/administración & dosificación , Antidepresivos/efectos adversos , Dolor Crónico/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Calidad de Vida , Clorhidrato de Duloxetina/uso terapéutico , Clorhidrato de Duloxetina/administración & dosificaciónRESUMEN
Complex Regional Pain Syndrome (CRPS) is characterized by pain, swelling, limited range of motion, skin changes, vasomotor instability, and bone demineralization. This study aims to assess the efficacy of botulinum toxin type A (BoNT-A) in the treatment of CRPS. We conducted a systematic literature review following the PRISMA guidelines, using the PICO strategy (Patient, Intervention, Comparison and Outcome) with the following criteria: P = Patients with CRPS; I = Botulinum toxin; C = Placebo or active drug; and O = Pain relief. Three randomized controlled trials with placebo controls were included, involving a total of 64 patients, 36 of whom received BoNT-A in doses ranging from 40U to 200U. The studies examined both lumbar sympathetic block and local application methods. Botulinum toxin shows promise in alleviating pain associated with CRPS, particularly when used as an adjunct to lumbar sympathetic blockade. However, the limited number of studies and small sample sizes impede reaching definitive conclusions regarding its efficacy and safety. Notably, local applications (intradermal or subcutaneous) require further investigation, as current evidence is insufficient and reports indicate patient discomfort. While preliminary findings suggest potential benefits of BoNT-A in managing CRPS, larger randomized trials are necessary to confirm its efficacy and safety.
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Toxinas Botulínicas Tipo A , Síndromes de Dolor Regional Complejo , Síndromes de Dolor Regional Complejo/tratamiento farmacológico , Humanos , Toxinas Botulínicas Tipo A/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
This study aims to assess the efficacy of low-dose naltrexone (LDN) in treating chronic pain. We conducted a systematic review using the PICO strategy: (P) Patients with chronic pain, (I) Use of oral naltrexone, (C) Placebo or active drug and (O) Pain relief and quality of life. We included articles from PubMed, Scopus, Cochrane CENTRAL and EMBASE databases. Seven randomized clinical trials involving 406 patients were analyzed. The doses ranging from 2 to 4.5 mg once daily across all studies. Various chronic pain conditions were evaluated. The results suggest that low-dose naltrexone is not effective in managing chronic pain and improving the quality of life in patients with diverse chronic pain conditions. However, further research with larger sample sizes and standardized methodologies is necessary.
This study looks at how well low-dose naltrexone (LDN) works for treating long-lasting pain. We reviewed research where patients with chronic pain were given either LDN or a placebo (a fake treatment). We found eight studies that included a total of 421 patients. The LDN doses used ranged from very small amounts 24.5 mg, taken once a day. These studies looked at different types of chronic pain. Our results suggest that LDN cannot help to reduce pain and improve the quality of life for people with chronic pain. However, more research with larger groups of people and consistent methods is needed to confirm these findings.
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Dolor Crónico , Naltrexona , Antagonistas de Narcóticos , Humanos , Dolor Crónico/tratamiento farmacológico , Naltrexona/administración & dosificación , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/administración & dosificación , Antagonistas de Narcóticos/uso terapéutico , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoAsunto(s)
Anestesia , Dengue , Atención Perioperativa , Humanos , Atención Perioperativa/métodos , Anestesia/métodosRESUMEN
OBJECTIVE: This systematic literature review aims to evaluate the effectiveness of transdermal opioids in managing cancer pain and their impact on the quality of life (QoL) of patients. DATA SOURCES: A systematic literature review conducted following the PRISMA protocol, focusing on randomized clinical trials found in the Lilacs, Embase, PubMed, and SciELO databases over the last 20 years. STUDY SELECTION AND DATA EXTRACTION: We included randomized clinical trials, published in English, Portuguese, or Spanish, which assessed the impact of transdermal opioids on the QoL. Data extraction was facilitated using the Rayyan app. DATA SYNTHESIS: Six articles meeting the inclusion and exclusion criteria were analyzed. These studies covered a population ranging from 24 to 422 cancer patients experiencing moderate to severe pain. The risk of bias was assessed in each study, generally being categorized as uncertain or high. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: The findings indicate that the analgesic effectiveness and side effects of transdermal formulations (specifically buprenorphine and fentanyl) for managing moderate to severe cancer pain are comparable to, or in some cases superior to, those of oral opioids traditionally employed. CONCLUSIONS: Transdermal therapy was suggested to have several advantages over oral opioid therapy in enhancing cancer patients' QoL. These benefits span various dimensions, including pain management, physical functioning, mental health, vitality, overall patient improvement, anger/aversion, strength/activity, general QoL, cognitive and emotional functions, fatigue, and insomnia.
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Several chemical substances cause toxicological damage to individuals, triggering Exogenous Intoxication (EI) with relevant fatal potential. It is, therefore, essential to describe and compare the epidemiological profile of EI cases reported in Bahia before and during the COVID-19 pandemic. A quantitative analytical approach was used, and secondary data were extracted, in August 2022, from the Notifiable Diseases Information System, cases of EI between January 2018 and December 2021, Bahia. Age, sex, color, circumstance, and causative agent were analyzed and described in frequency and proportions, 12,838 cases of EI were reported between 2018-2019. The highest incidence occurred in individuals aged 20-59 years (57.8%), females (59%), and browns (48.8%). Among toxic agents, medication (40.3%) stood out, followed by food and beverages (10%), rodenticides (6.8%), and drugs of abuse (6%). Among the circumstances: suicide attempt was highlighted (33.5%). In 2020 and 2021, there were 11,279 cases, higher incidence in individuals aged 20-59 years (59.5%), females (58%), and browns (55%). The toxic agent medication (41.9%) stood out, followed by drugs (10.2%), food and beverages (7.8%), and household products (5.7%). Similar to the previous period, suicide led among circumstances (36.5%). The pandemic did not seem to affect epidemiology significantly. However, the almost 50% increase in the frequency of EI cases due to drug abuse, reinforces the World Report on Drugs (2021), which pointed to a worldwide growth of drugs consumption during the pandemic and alerts attention to mental health of Brazilians.(AU)
Diversas substâncias químicas causam danos toxicológicos aos indivíduos, podendo deflagrar intoxicação exógena (IE) com relevante potencial fatal. É imprescindível assim, descrever e comparar perfil o epidemiológico dos casos de IE notificados na Bahia antes e durante a pandemia da COVID-19. Utilizou-se abordagem quantitativa analítica, com dados secundários extraídos, em agosto de 2022, do Sistema de Informação de Agravos de Notificação, sobre casos de IE, entre janeiro de 2018 a dezembro de 2021, na Bahia. Variáveis idade, sexo, cor, circunstância, agente causador foram analisadas e descritas em frequência e proporções. Foram notificados 12.838 casos de IE entre 2018-2019, a maior incidência ocorreu em indivíduos de 20-59 anos (57,8%), sexo feminino (59%), pardos (48,8%). Entre agentes tóxicos, a principal causa foi medicamentos (40,3%), seguindo alimentos e bebidas (10%), raticidas (6,8%) e drogas de abuso (6%). Dentre circunstâncias, o principal motivo foi tentativa de suicídio (33,5%). Entre 2020-2021, foram 11.279 casos, maior incidência indivíduos de 20-59 anos (59,5%), sexo feminino (58%) e pardos (55%). Destacou-se o agente tóxico medicamentos (41,9%), seguindo drogas (10,2%), alimentos e bebidas (7,8%), produtos de uso domiciliar (5,7%). Quanto às circunstâncias liderou a tentativa de suicídio (36,5%). A pandemia não pareceu afetar significativamente a epidemiologia, porém, o aumento de quase 50% na frequência dos casos de IE por drogas de abuso, comparativamente ao período anterior, reforça o Relatório Mundial sobre Drogas (2021), que apontou crescimento mundial do consumo na pandemia e sugere-se um alerta sobre a saúde mental dos brasileiros.(AU)
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INTRODUCTION: Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events. METHODS: MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity. RESULTS: The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable. CONCLUSION: There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.
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Anestesia Raquidea , Fentanilo , Humanos , Fentanilo/efectos adversos , Anestesia Raquidea/efectos adversos , Analgésicos Opioides/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sufentanilo/efectos adversos , Anestésicos Locales/efectos adversos , Dolor PostoperatorioRESUMEN
Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
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Anestesiología , Hipersensibilidad a las Drogas/etiología , Guías de Práctica Clínica como Asunto , Anafilaxia/etiología , Brasil , Humanos , Periodo PerioperatorioRESUMEN
Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.
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Humanos , Niño , Adulto , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/etiología , Periodo Perioperatorio , Anafilaxia/diagnóstico , Anafilaxia/etiología , Sociedades Médicas , Vasodilatadores/efectos adversos , Técnicas In Vitro , Mastocitosis/complicaciones , Brasil , Cuidados Preoperatorios , Inmunoglobulina E/inmunología , Bradiquinina/efectos adversos , Pruebas Cutáneas/métodos , Factores de Riesgo , Deficiencia de IgA/complicaciones , Hipersensibilidad a las Drogas/fisiopatología , Alergia e Inmunología , Evaluación de Síntomas , Anafilaxia/fisiopatología , Anestesiología , Angioedema/inducido químicamente , Terminología como AsuntoRESUMEN
Abstract The purpose of the Brazilian Society of Anesthesiology (SBA)'s Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
Resumo O propósito desta atualização das Recomendações da Sociedade Brasileira de Anestesiologia (SBA) para Segurança em Anestesia Regional foi apresentar novas diretrizes com base na relevância e atualidade clínica nos aspectos de segurança relacionados a analgesia e anestesia regional. Este artigo visa prover uma visão ampla sobre o conhecimento atual no tocante a assepsia e antissepsia pré-procedimento, fatores de risco, diagnóstico e tratamento das complicações infecciosas decorrentes das técnicas anestésicas. Também visa esclarecer sobre o uso de materiais reprocessados na prática da anestesia regional, estabelecer as implicações no manejo asséptico de frascos e ampolas e elucidar sobre a relação custo-efetividade no preparo de soluções a serem administradas continuamente em bloqueios regionais. As bases de dados eletrônicas foram pesquisadas entre Janeiro de 2011 (final da pesquisa de literatura das diretrizes anteriores da SBA sobre segurança em anestesia regional) e Setembro de 2019. Um total de 712 artigos foram encontrados, dos quais 201 foram incluídos para análise posterior e 82 novos estudos foram acrescentados nesta revisão. O sistema de Avaliação, Desenvolvimento e Avaliação da Classificação das Recomendações (GRADE) foi utilizado para avaliar a qualidade do estudo individual e classificar a força da evidência. Esta revisão foi elaborada por membros da Comissão de Normas Técnicas da SBA.
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Humanos , Infecciones/etiología , Anestesia de Conducción/efectos adversos , Bloqueo Nervioso/efectos adversos , Brasil , Factores de Riesgo , Guías de Práctica Clínica como Asunto , Anestesia de Conducción/métodos , Bloqueo Nervioso/métodosRESUMEN
The purpose of the Brazilian Society of Anesthesiology's (SBA) Regional Anesthesia Safety Recommendations Update is to provide new guidelines based on the current relevant clinical aspects related to safety in regional anesthesia and analgesia. The goal of the present article is to provide a broad overview of the current knowledge regarding pre-procedure asepsis and antisepsis, risk factors, diagnosis and treatment of infectious complications resulting from anesthetic techniques. It also aims to shed light on the use of reprocessed materials in regional anesthesia practice to establish the effects of aseptic handling of vials and ampoules, and to show cost-effectiveness in the preparation of solutions to be administered continuously in regional blockades. Electronic databases were searched between January 2011 (final date of the literature search for the past SBA recommendations for safety in regional anesthesia) and September 2019. A total of 712 publications were found, 201 of which were included for further analysis, and 82 new publications were added into the review. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of each study and to classify the strength of evidence. The present review was prepared by members of the SBA Technical Standards Committee.
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Anestesia de Conducción/efectos adversos , Infecciones/etiología , Bloqueo Nervioso/efectos adversos , Anestesia de Conducción/métodos , Brasil , Humanos , Bloqueo Nervioso/métodos , Guías de Práctica Clínica como Asunto , Factores de RiesgoRESUMEN
Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA), interessados no tema anafilaxia perioperatória, reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar ambos os especialistas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.
Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA), interested in the topic of perioperative anaphylaxis, have met to strengthen collaboration between the two societies in the study of this topic and to draft a joint document that can provide guidance to members of both societies. The purpose of this series of two articles is to provide the latest evidence based on the collaborative view of both societies. This first article will cover the most current definitions, treatment modalities, and guidelines for management after a perioperative event. The second article will discuss major causative agents and whether investigation has been conducted with proper tests.