RESUMEN
OBJECTIVE: To present the Pain-Track, a novel framework for the description and analysis of the pain experience based on its temporal evolution, around which intensity and other attributes of pain (texture, anatomy), interventions and clinical symptoms can be registered. This time-series approach can provide valuable insight on the expected evolution of the pain typically associated with different medical conditions and on time-varying (risk) factors associated with the temporal dynamics of pain. RESULTS: We illustrate the use of the framework to explore hypotheses on the temporal profile of the pain associated with an acute injury (bone fracture), and the magnitude of the pain burden it represents. We also show that, by focusing on the critical dimensions of the pain experience (intensity and time), the approach can help map different conditions to a common scale directly relating to the experiences of those who endure them (time in pain), providing the basis for the quantification of the burden of pain inflicted upon individuals or populations. An electronic version for data entry and interpretation is also presented.
Asunto(s)
Dolor , Humanos , Dimensión del DolorRESUMEN
Avaliou-se a recuperação anestésica e a analgesia residual da infusão contínua (IC) de fentanil (F), lidocaína (L), cetamina (K) e fentanil-lidocaína-cetamina (FLK), associados à anestesia total intravenosa com o propofol, em cadelas submetidas à ovariossalpingo-histerectomia. Foram utilizados 32 animais pré-medicados com acepromazina, distribuídos em quatro grupos de acordo com o tratamento analgésico: F: bolus de 0,0036mg/kg de fentanil e IC de 0,0036mg mg/kg/h; L: bolus de 3mg/kg de lidocaína e IC de 3mg/kg/h; K: bolus de 0,6mg/kg de cetamina e IC de 0,6mg/kg/h; e FLK: bolus e IC dos três fármacos nas doses supracitadas. Após o bolus do tratamento analgésico, foi realizada a indução e o início da IC do tratamento analgésico e do propofol. Para avaliação da recuperação anestésica, foram considerados os tempos de extubação, decúbito esternal, posição quadrupedal e os efeitos adversos. A avaliação da analgesia foi realizada por meio da escala visual analógica e modificada de Glasgow, durante seis horas. Os efeitos adversos observados foram vômito, sialorreia e tremor muscular. Receberam analgesia de resgate 100% dos animais do grupo F, 87,5% do K, 50% do L e 12,5% do FLK. O FLK demonstrou maior analgesia, e a recuperação anestésica foi semelhante em todos os grupos.(AU)
The anesthetic recovery and residual analgesia of continuous rate infusion (CRI) of fentanyl (F), lidocaine (L), ketamine (K) and fentanyl-lidocaine-ketamine (FLK) associated with total intravenous anesthesia with propofol in bitches submitted to ovariohysterectomy were evaluated. 32 animals were used, pre-medicated with acepromazine and distributed into four groups according to analgesic treatment: F loading dose (LD) of 0.0036mg/kg fentanyl, and CRI of 0.0036mg/kg/h, L: LD of 3mg/kg lidocaine, and CRI of 3mg/kg/h; K: LD of 0.6mg/kg ketamine, and CRI of 0.6mg/kg/h and FLK: LD and CRI of the three drugs in the above mentioned doses. After the LD of analgesic treatment, the induction was performed and the CRI of the analgesic treatment and propofol started. To evaluate the anesthetic recovery, the time of extubation, sternal decubitus, quadrupedal position and adverse effects were considered. The analgesia evaluation was performed using the visual scale and modified Glasgow for six hours. The adverse effects observed were vomiting, sialorrhea and muscle tremor. 100% of the animals in group F, 87.5% of K, 50% of L and 12.5% of FLK received rescue analgesia. FLK demonstrated greater analgesia, and anesthesia recovery was similar in all groups.(AU)
Asunto(s)
Animales , Femenino , Perros , Periodo de Recuperación de la Anestesia , Propofol/administración & dosificación , Fentanilo/administración & dosificación , Anestésicos Combinados/administración & dosificación , Ketamina/administración & dosificación , Lidocaína/administración & dosificación , Salpingostomía/veterinaria , Ovariectomía/veterinaria , Histerectomía/veterinariaRESUMEN
Avaliou-se a recuperação anestésica e a analgesia residual da infusão contínua (IC) de fentanil (F), lidocaína (L), cetamina (K) e fentanil-lidocaína-cetamina (FLK), associados à anestesia total intravenosa com o propofol, em cadelas submetidas à ovariossalpingo-histerectomia. Foram utilizados 32 animais pré-medicados com acepromazina, distribuídos em quatro grupos de acordo com o tratamento analgésico: F: bolus de 0,0036mg/kg de fentanil e IC de 0,0036mg mg/kg/h; L: bolus de 3mg/kg de lidocaína e IC de 3mg/kg/h; K: bolus de 0,6mg/kg de cetamina e IC de 0,6mg/kg/h; e FLK: bolus e IC dos três fármacos nas doses supracitadas. Após o bolus do tratamento analgésico, foi realizada a indução e o início da IC do tratamento analgésico e do propofol. Para avaliação da recuperação anestésica, foram considerados os tempos de extubação, decúbito esternal, posição quadrupedal e os efeitos adversos. A avaliação da analgesia foi realizada por meio da escala visual analógica e modificada de Glasgow, durante seis horas. Os efeitos adversos observados foram vômito, sialorreia e tremor muscular. Receberam analgesia de resgate 100% dos animais do grupo F, 87,5% do K, 50% do L e 12,5% do FLK. O FLK demonstrou maior analgesia, e a recuperação anestésica foi semelhante em todos os grupos.(AU)
The anesthetic recovery and residual analgesia of continuous rate infusion (CRI) of fentanyl (F), lidocaine (L), ketamine (K) and fentanyl-lidocaine-ketamine (FLK) associated with total intravenous anesthesia with propofol in bitches submitted to ovariohysterectomy were evaluated. 32 animals were used, pre-medicated with acepromazine and distributed into four groups according to analgesic treatment: F loading dose (LD) of 0.0036mg/kg fentanyl, and CRI of 0.0036mg/kg/h, L: LD of 3mg/kg lidocaine, and CRI of 3mg/kg/h; K: LD of 0.6mg/kg ketamine, and CRI of 0.6mg/kg/h and FLK: LD and CRI of the three drugs in the above mentioned doses. After the LD of analgesic treatment, the induction was performed and the CRI of the analgesic treatment and propofol started. To evaluate the anesthetic recovery, the time of extubation, sternal decubitus, quadrupedal position and adverse effects were considered. The analgesia evaluation was performed using the visual scale and modified Glasgow for six hours. The adverse effects observed were vomiting, sialorrhea and muscle tremor. 100% of the animals in group F, 87.5% of K, 50% of L and 12.5% of FLK received rescue analgesia. FLK demonstrated greater analgesia, and anesthesia recovery was similar in all groups.(AU)
Asunto(s)
Animales , Femenino , Perros , Periodo de Recuperación de la Anestesia , Propofol/administración & dosificación , Fentanilo/administración & dosificación , Anestésicos Combinados/administración & dosificación , Ketamina/administración & dosificación , Lidocaína/administración & dosificación , Salpingostomía/veterinaria , Ovariectomía/veterinaria , Histerectomía/veterinariaRESUMEN
OBJECTIVE: To evaluate the postoperative analgesic effects of a constant rate infusion (CRI) of either fentanyl (FENT), lidocaine (LIDO), ketamine (KET), dexmedetomidine (DEX), or the combination lidocaine-ketamine-dexmedetomidine (LKD) in dogs. STUDY DESIGN: Randomized, prospective, blinded, clinical study. ANIMALS: Fifty-four dogs. METHODS: Anesthesia was induced with propofol and maintained with isoflurane. Treatments were intravenous (IV) administration of a bolus at start of anesthesia, followed by an IV CRI until the end of anesthesia, then a CRI at a decreased dose for a further 4 hours: CONTROL/BUT (butorphanol 0.4 mg kg(-1), infusion rate of saline 0.9% 2 mLkg(-1) hour(-1)); FENT (5 µg kg(-1), 10 µg kg(-1) hour(-1), then 2.5 µg kg(-1) hour(-1)); KET (1 mgkg(-1) , 40 µg kg(-1) minute(-1), then 10 µg kg(-1) minute(-1) ; LIDO (2 mg kg(-1), 100 µg kg(-1) minute(-1), then 25 µg kg(-1) minute(-1)); DEX (1 µgkg(-1), 3 µg kg(-1) hour(-1), then 1 µg kg(-1) hour(-1)); or a combination of LKD at the aforementioned doses. Postoperative analgesia was evaluated using the Glasgow composite pain scale, University of Melbourne pain scale, and numerical rating scale. Rescue analgesia was morphine and carprofen. Data were analyzed using Friedman or Kruskal-Wallis test with appropriate post-hoc testing (p < 0.05). RESULTS: Animals requiring rescue analgesia included CONTROL/BUT (n = 8), KET (n = 3), DEX (n = 2), and LIDO (n = 2); significantly higher in CONTROL/BUT than other groups. No dogs in LKD and FENT groups received rescue analgesia. CONTROL/BUT pain scores were significantly higher at 1 hour than FENT, DEX and LKD, but not than KET or LIDO. Fentanyl and LKD sedation scores were higher than CONTROL/BUT at 1 hour. CONCLUSIONS AND CLINICAL RELEVANCE: LKD and FENT resulted in adequate postoperative analgesia. LIDO, CONTROL/BUT, KET and DEX may not be effective for treatment of postoperative pain in dogs undergoing ovariohysterectomy.
Asunto(s)
Analgesia/veterinaria , Dexmedetomidina/farmacología , Fentanilo/farmacología , Ketamina/farmacología , Lidocaína/farmacología , Dolor Postoperatorio/veterinaria , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/farmacología , Anestésicos Disociativos/administración & dosificación , Anestésicos Disociativos/farmacología , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/farmacología , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacología , Animales , Dexmedetomidina/administración & dosificación , Perros , Combinación de Medicamentos , Femenino , Fentanilo/administración & dosificación , Histerectomía/veterinaria , Ketamina/administración & dosificación , Lidocaína/administración & dosificación , Ovariectomía/veterinaria , Dolor Postoperatorio/prevención & controlRESUMEN
Epidural anesthesia is a locoregional anesthesia technique that provides abolition of nociceptive stimuli in retro-umbilical region. This study aimed to compare the efficacy of sensory and motor block of levobupivacaine and ropivacaine administered epidurally in cats. Six female cats were submitted to epidural anesthesia which received randomly, through blind study, three treatments at intervals of one week between these: group NaCl 0.9% (control); group levobupivacaine 0.5%; group ropivacaine 1%. After solutions infusion the nociceptive stimuli was proceeded by clamping technique. The sensory block was determined by visual analogue scale and simple descriptive scale and through heart rate (HR) and respiratory rate variances (RR). Furthermore, the motor block was evaluated using a modified Bromage score and patellar tendon reflex test. The analysis of variance and the Kruskal-Wallis test were used for statistical analysis. No significant differences were observed for the variables HR, RR, sensory and motor block, however, significant difference was detected in latency periods. The use of ropivacaine and bupivacaine provide equivalent efficacy regarding the sensory and motor block, however, the sensory and motor latency times are greater in the use of ropivacaine.
A anestesia epidural é uma técnica de anestesia locorregional que propicia abolição de estímulos nociceptivos na região retro-umbilical. Este estudo visou comparar a eficácia do bloqueio sensitivo e motor da levobupivacaína e da ropivacaína, administradas por via epidural, em gatos. Foram submetidas ao bloqueio epidural, seis gatas as quais receberam de forma aleatória, através de estudo cego, três tratamentos com intervalos de uma semana entre estes: grupo NaCl 0,9% (controle); grupo levobupivacaína 0,5%; grupo ropivacaína 1%. Após a infusão das soluções procedeu-se estímulos nociceptivos através da técnica de pinçamentos. O bloqueio sensitivo foi determinado através das escalas visual analógica e simples descritiva e pelas variações de frequência cardíaca (FC) e respiratória (FR). Ademais, o bloqueio motor foi avaliado através do Escore de Bromage modificado e teste do reflexo do tendão patelar. Aplicou-se os teste da Análise de Variância e de Kruskal-Wallis para análise estatística dos dados. Não houve diferença significativa entre as variáveis FC, FR, bloqueio sensitivo e motor, entretanto, observou-se diferença nos períodos de latência. O uso da ropivacaína e da bupivacaína conferem eficácia equivalentes no que tange o bloqueio sensitivo e motor, diferindo nos tempos de latência sensitiva e motora, os quais são maiores no uso da ropivacaína.
RESUMEN
Epidural anesthesia is a locoregional anesthesia technique that provides abolition of nociceptive stimuli in retro-umbilical region. This study aimed to compare the efficacy of sensory and motor block of levobupivacaine and ropivacaine administered epidurally in cats. Six female cats were submitted to epidural anesthesia which received randomly, through blind study, three treatments at intervals of one week between these: group NaCl 0.9% (control); group levobupivacaine 0.5%; group ropivacaine 1%. After solutions infusion the nociceptive stimuli was proceeded by clamping technique. The sensory block was determined by visual analogue scale and simple descriptive scale and through heart rate (HR) and respiratory rate variances (RR). Furthermore, the motor block was evaluated using a modified Bromage score and patellar tendon reflex test. The analysis of variance and the Kruskal-Wallis test were used for statistical analysis. No significant differences were observed for the variables HR, RR, sensory and motor block, however, significant difference was detected in latency periods. The use of ropivacaine and bupivacaine provide equivalent efficacy regarding the sensory and motor block, however, the sensory and motor latency times are greater in the use of ropivacaine.
A anestesia epidural é uma técnica de anestesia locorregional que propicia abolição de estímulos nociceptivos na região retro-umbilical. Este estudo visou comparar a eficácia do bloqueio sensitivo e motor da levobupivacaína e da ropivacaína, administradas por via epidural, em gatos. Foram submetidas ao bloqueio epidural, seis gatas as quais receberam de forma aleatória, através de estudo cego, três tratamentos com intervalos de uma semana entre estes: grupo NaCl 0,9% (controle); grupo levobupivacaína 0,5%; grupo ropivacaína 1%. Após a infusão das soluções procedeu-se estímulos nociceptivos através da técnica de pinçamentos. O bloqueio sensitivo foi determinado através das escalas visual analógica e simples descritiva e pelas variações de frequência cardíaca (FC) e respiratória (FR). Ademais, o bloqueio motor foi avaliado através do Escore de Bromage modificado e teste do reflexo do tendão patelar. Aplicou-se os teste da Análise de Variância e de Kruskal-Wallis para análise estatística dos dados. Não houve diferença significativa entre as variáveis FC, FR, bloqueio sensitivo e motor, entretanto, observou-se diferença nos períodos de latência. O uso da ropivacaína e da bupivacaína conferem eficácia equivalentes no que tange o bloqueio sensitivo e motor, diferindo nos tempos de latência sensitiva e motora, os quais são maiores no uso da ropivacaína.