RESUMO
Introdução: A dor, sintoma comum em pacientes oncológicos, é mal controlada com a terapia convencional em cerca de 10% a 25% dos casos, levando a uma piora significativa da qualidade de vida. Para esses pacientes, a terapia intervencionista, como bloqueios nervosos, procedimentos neurolíticos ou cordotomia e aquelas que necessitam de tratamento contínuo, como a terapia de infusão, levam a bons resultados no controle da dor. Método: Esse artigo é uma revisão bibliográfica realizada entre os anos de 2010 até 2018 sobre métodos intervencionistas para o tratamento da dor em pacientes oncológicos. Resultados: Bloqueios de nervos periféricos são uma forma de tratar a dor relacionada ao câncer, uma única injeção ou série de injeções de anestésico local com ou sem adjuvantes, com a expectativa de alívio da dor de 2 a 6 semanas. Quase todas as regiões das extremidades superior e inferior e a maioria das áreas da cabeça, pescoço e tronco podem ser anestesiados por bloqueios de nervos periféricos. Neurólise com agentes químicos ou físicos é uma outra opção, utilizada para bloquear nervos espinhais ou cranianos e os plexos autonômicos, oferece alívio da dor por alguns meses. A neurólise química é realizada com álcool de alta concentração ou fenol, já a física é através da thermal radiofrequency lesioning (RFL) ou a crioanalgesia. Conclusão: O uso de medicamentos neuroaxiais, proporcionam redução da dose de analgésicos opioides se comparada a dose via oral necessária para obter analgesia semelhante. Isso reduz os efeitos secundários desagradáveis. Os candidatos à terapia neuroaxial contínua são aqueles com requisitos crescentes de opiáceos, dor de difícil controle ou intolerância ao plano analgésico escolhido.
Introduction: Cancer pain management by conventional therapy is ineffective in about 10-25% of cases, leading to a significant decrease in quality of life. interventional therapy, applying either one-time session of nerve blocks, neurolytic procedures, or cordotomy, or long-term treatments as infusion therapy is able to improve cancer pain management. Methodology: This article is a bibliographic review carried out between 2010 and 2018 on interventional methods for the treatment of pain in cancer patients. Results: Peripheral nerve blocks are a way to treat oncology pain. A single injection or a series of injections of local anesthetic with or without adjuvants, with an expectation of pain relief of 2 to 6 weeks. Almost all regions of the upper and lower extremities and most areas of the head, neck and trunk may be anesthetized by peripheral nerve blocks. Neurolysis with chemical or physical agents is another option used to block spinal or cranial nerves and autonomic plexuses offers pain relief for a few months. Chemical neurolysis is performed with high concentrated alcohol or phenol, yet the physical is usually through thermal radiofrequency lesioning (RFL) or cryoanalgesia. Conclusion: The use of neuroaxial drugs, provide a dose reduction of opioid analgesics use compared to the oral dose required to obtain similar analgesia. This reduces unpleasant side effects. The candidates for continuous neuroaxial therapy are those with increasing requirements for opioids, pain of difficult control or intolerance to the chosen analgesic plan.
Assuntos
Dor do Câncer , Anestésicos , DorRESUMO
Probiotics have emerged as a promising intervention for the prevention of respiratory tract infections (RTIs) in children. Assess the effect of probiotics on prevention of RTIs in children and adolescents. MEDLINE, EMBASE, LILACS, SCIELO, CINAHL, SCOPUS, and Web of Science. Key words: "respiratory tract infections" AND probiotics. Randomized controlled trials RCT assessing the effect of probiotics on RTIs in children and adolescents were included. Two reviewers, working independently, to identify studies that met the eligibility criteria. Main and secondary outcomes were RTIs and adverse effects, respectively. Twenty-one trials with 6.603 participants were included. Pairwise meta-analysis suggested that Lactobacillus casei rhamnosus (LCA) was the only effective probiotic to the rate of RTIs compared to placebo (RR0.38; Crl 0.19-0.45). Network analysis showed that the LCA exhibited 54.7% probability of being classified in first, while the probability of Lactobacillus fermentum CECT5716 (LFC) being last in the ranking was 15.3%. LCA showed no better effect compared to other probiotic strains by indirect analysis. This systematic review found a lack of evidence to support the effect of probiotic on the incidence rate of respiratory infections in children and adolescents. Pediatr Pulmonol. 2017;52:833-843. © 2017 Wiley Periodicals, Inc.