Asunto(s)
Adhesivo de Tejido de Fibrina/administración & dosificación , Adhesivos Tisulares/administración & dosificación , Cateterismo/efectos adversos , Pérdida de Líquido Cefalorraquídeo , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/terapia , Humanos , Inyecciones Epidurales , Masculino , Columna VertebralAsunto(s)
Golpe de Calor/complicaciones , Fallo Hepático/etiología , Enfermedad Aguda , Hemorragia Cerebral/diagnóstico , Terapia Combinada , Cuidados Críticos/métodos , Crioterapia , Diagnóstico Diferencial , Dopamina/uso terapéutico , Urgencias Médicas , Hígado Graso/complicaciones , Fluidoterapia , Golpe de Calor/diagnóstico , Golpe de Calor/terapia , Humanos , Fallo Hepático/terapia , Hígado Artificial , Masculino , Manitol/uso terapéutico , Abuso de Marihuana/complicaciones , Meningoencefalitis/diagnóstico , Persona de Mediana Edad , Plasma , Inconsciencia/diagnóstico , Inconsciencia/etiologíaRESUMEN
INTRODUCTION: Intense chronic pain is a very important health problem, as it has a high prevalence (5-10%), a multifactorial aetiology and its management is very often a very complex affair. Treatment of severe cases sometimes requires interventional approaches, such as continuous intrathecal infusion of opioids. CASE REPORT: We report the case of a 38-year-old female with intense neuropathic pain in the lower back and the lower limbs secondary to three operations on the L5-S1 lumbar segment. After implementing several different pharmacological regimes involving both oral and implanted systems (spinal cord stimulation and subarachnoid infusion pump with different pharmacological combinations) with no clinical improvement, intrathecal infusion with ziconotide was included in the protocol. CONCLUSIONS: Ziconotide is the first specific neuronal blocker that acts on the calcium channel by blocking the N-type voltage-dependent calcium channels. It is a new non-opioid analgesic with approved indication in the treatment of intense chronic pain, in patients who require intrathecal analgesics and are refractory to other analgesic treatments. Therefore, we shall have to consider this drug as a therapeutic alternative in patients do not experience sufficient relief with the pharmacological agents and means currently available to treat them.
Asunto(s)
Analgésicos no Narcóticos/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Dolor Postoperatorio/tratamiento farmacológico , Raíces Nerviosas Espinales , omega-Conotoxinas/uso terapéutico , Adulto , Analgesia Epidural , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedad Crónica , Terapia Combinada , Descompresión Quirúrgica , Remoción de Dispositivos , Femenino , Humanos , Bombas de Infusión/efectos adversos , Bombas de Infusión/microbiología , Bombas de Infusión Implantables , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/terapia , Meningitis/etiología , Neuralgia/cirugía , Neuralgia/terapia , Dolor Postoperatorio/terapia , Infecciones por Pseudomonas/etiología , Recurrencia , Fusión Vertebral , Raíces Nerviosas Espinales/fisiopatología , Raíces Nerviosas Espinales/cirugía , Espacio Subaracnoideo , Estimulación Eléctrica Transcutánea del Nervio , omega-Conotoxinas/administración & dosificación , omega-Conotoxinas/efectos adversosRESUMEN
INTRODUCTION: The effectiveness of a pharmaceutical care unit was assessed within a staged program for non-malignant severe chronic pain control in a multidisciplinary pain management unit at Consorcio Hospital General Universitario, Valencia, Spain. MATERIALS AND METHODS: One hundred and fifty patients with clinical indication for a major opioid were included in WHO's third analgesic rung by our medical team following careful triage. The pharmaceutical care unit, or phase II, monitored dosage titration for pain stabilization with absence of side effects, as well as the onset of subsequent chronic therapy. RESULTS: Upon program completion 75% of patients had their pain under control, having required 22.7 days on average for opiate dose titration. Mean daily dose was 22.3 mg, and constipation was prophylactically managed from the start. Fifty-nine percent of patients received subsequent chronic therapy with fentanyl transdermal patches at 25 microg/h; 10% followed suit with oral morphine solution, and 6% with controlled-release morphine. Twenty-five percent of the remaining patients had relevant events during the therapy titration stage, which led to therapy discontinuation and discharge because of lack of therapeutic effectiveness. After 24 months 70% of patients were still on initial doses. CONCLUSIONS: The effectiveness of our unit was demonstrated by the achievement of the program objectives.
Asunto(s)
Dolor/tratamiento farmacológico , Enfermedad Crónica , Índice de Severidad de la EnfermedadRESUMEN
A study was made to assess the impact of surgery on the hematological status and postoperative hematological recovery of 75 consecutive patients undergoing either reduction mammaplasty or dermolipectomy. Blood losses were estimated the morning after surgery, measuring decreases in hemoglobin level and hematocrit, while postoperative recovery was evaluated in terms of hemoglobin level and hematocrit at 10 weeks. The postoperative hemoglobin decrease was 2.69 g%, and the hematocrit dropped 7.25%. By 10 weeks, however, the patients had recovered their preoperative values. We found no significant differences in the evolution of hemoglobin level and hematocrit during the study between reduction mammaplasty and dermolipectomy patients. A significant positive correlation between surgical piece weight and postoperative reduction in hemoglobin concentration and hematocrit was observed. Conversely, at 10 weeks, a significant but negative correlation between surgical specimen weight and hemoglobin concentration and hematocrit was recorded. The anticipated weight of the surgical piece could thus be used as a predictor of intraoperative blood loss and of the speed of postoperative recovery. Since patients with surgical resection of > 3 kg remained anemic at 10 weeks, oral iron supplements could benefit this subset of patients.
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Pérdida de Sangre Quirúrgica , Electrocoagulación , Lipectomía , Mamoplastia , Adolescente , Adulto , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Persona de Mediana Edad , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. One hundred patients received either ketorolac 30 mg intramuscularly (IM) every 8 hours or metamizol 2 g IM every 8 hours for postoperative analgesia during the first 48 postoperative hours. Pain severity was assessed using a visual analog scale. Adverse events were recorded. There were no significant differences between the groups in terms of pain scores or frequency of adverse events throughout the study. Two postoperative hemorrhages were recorded in the ketorolac group. Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.