RESUMO
Abstract Background: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. Methods: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg−1 loading, 0.6 µg.kg−1.h−1 infusion) (Group 2), lidocaine (1.5 mg.kg−1 loading, 2 mg.kg−1.h−1 infusion), and dexmedetomidine infusions (1 µg.kg−1 loading, 0.5 µg.kg−1.h−1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg−1.h−1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. Results The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. Conclusion: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.
Assuntos
Humanos , Feminino , Dexmedetomidina/uso terapêutico , Procedimentos Cirúrgicos Robóticos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Infusões Intravenosas , Fentanila , Método Duplo-Cego , Estudos Prospectivos , Flatulência , Histerectomia , Lidocaína/uso terapêuticoRESUMO
BACKGROUND: Acute postoperative pain is associated with poor quality of recovery after surgery. Perioperative use of intravenous lignocaine or dexmedetomidine have demonstrated better pain control, early return of bowel function, and effects on quality of recovery. METHODS: Ninety-six women planned for elective robotic abdominal hysterectomy were randomized into four groups. Groups received lignocaine infusion (1.5 mg.kg-1 loading, 2 mg.kg-1.h-1 infusion) (Group I), dexmedetomidine infusion (1 µg.kg-1 loading, 0.6 µg.kg-1.h-1 infusion) (Group 2), lidocaine (1.5 mg.kg-1 loading, 2 mg.kg-1.h-1 infusion), and dexmedetomidine infusions (1 µg.kg-1 loading, 0.5 µg.kg-1.h-1 infusion) (Group 3), and normal saline 10 mL loading, 1 mL.kg-1.h-1 infusion) (Group 4). Primary outcome was visual analogue pain scores at 1, 2, 4, 12, and 24 hours after surgery. Secondary outcomes included postoperative fentanyl requirement, time of return of bowel sounds and flatus, QoR15 score on day 1, 2, and discharge. RESULTS: The VAS was significantly lower in Groups 2 and 3 compared to Groups 1 and 4. Total postoperative fentanyl consumption in the first 24 hours was 256.25 ± 16.36 mcg (Group 1), 177.71 ± 16.81 mcg (Group 2), 114.17 ± 16.19 mcg (Group 3), and 304.42 ± 31.26 mcg (Group 4), respectively. Time to return of bowel sounds and passage of flatus was significantly shorter in Groups 2 and 3 (p < 0.01). QoR15 scores after surgery were higher in Group 3 compared to Groups 1, 2, and 4, (p < 0.01) respectively. CONCLUSION: Combined infusion of lignocaine and dexmedetomidine significantly decreased postoperative pain, fentanyl consumption, and improved quality of recovery score after surgery in patients undergoing Robotic abdominal hysterectomy.
Assuntos
Dexmedetomidina , Procedimentos Cirúrgicos Robóticos , Dexmedetomidina/uso terapêutico , Método Duplo-Cego , Feminino , Fentanila , Flatulência , Humanos , Histerectomia , Infusões Intravenosas , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos ProspectivosRESUMO
Abstract Background: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery. Methods: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded. Results: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026). Conclusion: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.
Resumo Justificativa: Náusea e vômito no pós-operatório é a segunda queixa pós-operatória mais frequente após a dor. Sem profilaxia antiemética, a incidência de náusea e vômito no pós-operatório foi de 60−80% após cirurgia do ouvido médio. Dada a alta incidência relatada de náusea e vômito no pós-operatório, nosso objetivo foi avaliar o efeito da combinação de palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náusea e vômito no pós-operatório em pacientes submetidos a cirurgia do ouvido médio. Método: Sessenta e quatro pacientes programados para cirurgia de ouvido médio foram aleatoriamente divididos em dois grupos. Um recebeu a combinação de palonosetrona-dexametasona (grupo P) e o outro ondansetrona-dexametasona (grupo O) por via intravenosa antes da indução anestésica. A técnica anestésica foi padronizada em todos os pacientes. No pós-operatório, foram registradas incidência e gravidade das náuseas e vômitos, necessidade de antiemético de resgate, efeitos colaterais e índice de satisfação dos pacientes. Resultados: As características demográficas foram semelhantes nos grupos estudados. A diferença na incidência de náusea foi estatisticamente significante entre os grupos O e P apenas no intervalo de tempo entre 2 e 6 horas (p = 0,026). A incidência e gravidade de vômito não foram estatisticamente significantes entre os grupos O e P durante todo o período do estudo. A incidência geral de náusea e vômito no pós-operatório (0−24 horas de pós-operatório) foi de 37,5% no grupo O e de 9,4% no grupo P (p = 0,016). A combinação palonosetrona-dexametasona associou-se com redução do risco absoluto de 28%, redução do risco relativo de 75%, e o número necessário para tratar foi 4. O escore de satisfação do paciente foi maior no grupo P (p = 0,016). A frequência da medicação de resgate foi mais comum no grupo O (p = 0,026). Conclusão: A combinação de palonosetrona-dexametasona é superior à ondansetrona-dexametasona na prevenção da náusea e vômito no pós-operatório após cirurgia de ouvido médio.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Dexametasona/administração & dosagem , Ondansetron/administração & dosagem , Náusea e Vômito Pós-Operatórios/prevenção & controle , Palonossetrom/administração & dosagem , Método Duplo-Cego , Incidência , Estudos Prospectivos , Satisfação do Paciente , Náusea e Vômito Pós-Operatórios/epidemiologia , Quimioterapia Combinada , Orelha Média/cirurgia , Pessoa de Meia-Idade , Antieméticos/administração & dosagemRESUMO
BACKGROUND: Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60-80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery. METHODS: Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded. RESULTS: Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2-6hours only (p=0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0-24hours postoperatively) was 37.5% in group O and 9.4% in group P (p=0.016). Absolute risk reduction with palonosetron-dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient's satisfaction score was higher in group P than group O (p=0.016). The frequency of rescue medication was more common in group O than in group P patients (p=0.026). CONCLUSION: The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.
Assuntos
Dexametasona/administração & dosagem , Ondansetron/administração & dosagem , Palonossetrom/administração & dosagem , Náusea e Vômito Pós-Operatórios/prevenção & controle , Adulto , Antieméticos/administração & dosagem , Método Duplo-Cego , Quimioterapia Combinada , Orelha Média/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Adulto JovemRESUMO
ABSTRACT BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5 mcg/kg, propofol 1.5-2.0 mg/kg followed by succinylcholine 1.5 mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24 h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p > 0.05). The incidence of muscle fasciculation's was not significant between two groups (p = 0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p = 0.028). The incidence and severity of myalgia were significantly lower in group P (p < 0.05). CONCLUSION: Pregabalin 150 mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.
RESUMO JUSTIFICATIVA: A succinilcolina é comumente usada para atingir um bloqueio neuromuscular profundo, de início rápido e de curta duração. OBJETIVO: Comparar a eficácia de pregabalina na prevenção de mialgia e fasciculação induzidas por succinilcolina. DESENHO: Estudo prospectivo, randômico, duplo-cego e controlado por placebo. MATERIAIS E MÉTODOS: Pacientes de ambos os sexos submetidos a cirurgia eletiva de coluna foram aleatoriamente divididos em dois grupos. Os pacientes do Grupo P (pregabalina) receberam 150 mg de pregabalina oral uma hora antes da indução da anestesia e os pacientes do Grupo C (controle) receberam placebo. A anestesia foi induzida com fentanil (1,5 mcg/kg) e propofol (1,5-2,0 mg/kg), seguidos de succinilcolina 1,5 mg/kg. A intensidade da fasciculação foi avaliada por um observador, cego para a alocação dos grupos, com uma escala de 4 pontos. Um observador cego registrou o grau pós-operatório de mialgia após 24 horas de cirurgia. Para o alívio da dor no pós-operatório, fentanil foi usado em sistema de analgesia controlada pelo paciente. RESULTADOS: Os dados demográficos de ambos os grupos eram comparáveis (p > 0,05). A incidência de fasciculação muscular não foi significativa entre os dois grupos (p = 0,707), enquanto mais pacientes do Grupo C apresentaram fasciculação de moderada a grave em relação ao Grupo P (p = 0,028). A incidência e a gravidade da mialgia foram significativamente menores no grupo P (p < 0,05). CONCLUSÃO: Pregabalina (150 mg) previne mialgia e fasciculação induzidas por succinilcolina, além de diminur o consumo de fentanil em cirurgia eletiva de coluna.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Succinilcolina/administração & dosagem , Fasciculação/prevenção & controle , Mialgia/prevenção & controle , Pregabalina/uso terapêutico , Coluna Vertebral/cirurgia , Succinilcolina/efeitos adversos , Propofol/administração & dosagem , Fentanila/administração & dosagem , Método Duplo-Cego , Incidência , Estudos Prospectivos , Analgesia Controlada pelo Paciente/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Fasciculação/induzido quimicamente , Fasciculação/epidemiologia , Mialgia/induzido quimicamente , Mialgia/epidemiologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). CONCLUSION: Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.
Assuntos
Fasciculação/prevenção & controle , Mialgia/prevenção & controle , Pregabalina/uso terapêutico , Succinilcolina/administração & dosagem , Adulto , Analgesia Controlada pelo Paciente/métodos , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos/métodos , Fasciculação/induzido quimicamente , Fasciculação/epidemiologia , Feminino , Fentanila/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mialgia/induzido quimicamente , Mialgia/epidemiologia , Propofol/administração & dosagem , Estudos Prospectivos , Coluna Vertebral/cirurgia , Succinilcolina/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p>0.05). The incidence of muscle fasciculation's was not significant between two groups (p=0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p=0.028). The incidence and severity of myalgia were significantly lower in group P (p<0.05). CONCLUSION: Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.
RESUMO
OBJETIVO: La fusión intercorporal seguida de disectomía cervical anterior para la enfermeda degenerativa del disco (EDD) es una enseñanza tradicional y convencional. El diseño de este estudio prospectivo fue para evaluar los resultados clínicos a largo plazo en los pacientes operados de hernia cervical del disco con solo micro-disectomía cervical anterior (SMCA). MÉTODOS: Se incluyeron en el estudio, desde enero del 2004 a marzo del 2007, pacientes con evidencia radiológica de enfermedad cervical discal de uno o dos niveles y fueron seguidos por un mínimo de 6 meses y un máximo de 46 meses. A todos los pacientes se les realizo solo microdisectomía cervical anterior, por un solo cirujano, usando un microscopio Leica. Se evaluaron a los pacientes en la mejoría de los síntomas y signos clínicos, estatus laboral usando la graduación de Nurick y los criterios de Odom. RESULTADOS: De los 33 pacientes operados durante el período de estudio; 28 eran varones y su edad vario entre 28 a 65 años con una media de 45.72 años. La hernia de disco C5-6 fue el nivel más comúnmente afectado. Cinco pacientes tuvieron dos niveles de hernia del disco y fueron operados de dos niveles en la misma cirugía. La presentación más común fue radiculomielopatia seguida por dolor y mielopatia. Dolor radicular fue el síntoma más temprano que desapareció después de la cirugía seguido por los síntomas mielopaticos. CONCLUSIÓN: Esta técnica es un tratamiento quirúrgico adecuado para la mayoría de casos de disco cervical prolapsado; no requiere fusión y evita problemas específicos y complicaciones asociados a la instrumentación y fusión. Nosotros, aun continuamos el estudio de seguimiento de estos pacientes, pero hasta la fecha ningún problema tardío considerable ha llegado a ser evidente. Pensamos que la mejor respuesta a esta pregunta se puede obtener solamente con un estudio prospectivo multicentrico doble ciego randomizado.