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Introducción: Las mioclonías son contracciones musculares paroxísticas de corta duración o pérdida abrupta del tono muscular, denominadas mioclonías positivas y negativas, respectivamente. Se presenta un caso clínico de mioclonías positivas y negativas generalizadas y se pretende describir los múltiples mecanismos fisiopatológicos y etiologías que lo desencadenan. Presentación del caso: Hombre de 35 años, con diabetes mellitus tipo 1 complicada con enfermedad renal diabética en hemodiálisis, desarrolló una bacteriemia asociada a catéter por Staphylococcus aureus y presentó mioclonías positivas y negativas. Se identificaron como posibles desencadenantes la uremia, la infección y los fármacos con potencial promioclónico; el hallazgo incidental de una lesión isquémica en núcleo caudado no explicaba la semiología encontrada en el paciente. Se hizo el control y retiro de todos los factores promioclónicos enunciados, junto a manejo farmacológico con levetiracetam, y con ello se logró el control de los síntomas. Discusión: Los pacientes con enfermedad renal crónica son susceptibles a la acumulación de productos tóxicos de tipo guanidinas, que tienen potencial para producir mioclonías. Además, las infecciones, el uso de fármacos con potencial promioclónico y lesiones estructurales como las isquemias corticales son etiologías que deben considerarse en el diagnóstico diferencial. El mayor impacto en los síntomas se observa con el control del factor desencadenante, y, en caso de persistir, la terapia farmacológica proporciona buenos resultados. Conclusión: Las mioclonías son trastornos del movimiento relativamente comunes en la enfermedad renal crónica. La identificación del desencadenante es crucial para su manejo junto al uso de fármacos con actividad antimioclónica.

Introduction: Myoclonus are paroxysmal muscle contractions of short duration or abrupt loss of muscle tone, called positive and negative myoclonus respectively. A clinical case of generalized positive and negative myoclonus is presented and the aim is to describe the multiple pathophysiological mechanisms and etiologies that trigger it. Case presentation: A 35-year-old man with type 1 diabetes mellitus complicated by diabetic kidney disease on hemodialysis developed catheter-associated bacteremia due to Staphylococcus aureus and presented positive and negative myoclonus. Uremia, infection, and drugs with pro-myoclonic potential were identified as possible triggers; The incidental finding of an ischemic lesion in the caudate nucleus did not explain the semiology found in the patient. The control and removal of all the pro-myoclonic factors mentioned was carried out, along with pharmacological management with levetiracetam, thus achieving control of the symptoms. Discussion: Patients with chronic kidney disease are susceptible to the accumulation of guanidine-type toxic products, which have the potential to produce myoclonus. Furthermore, infections, the use of drugs with pro-myoclonic potential and structural lesions such as cortical ischemia are etiologies that should be considered in the differential diagnosis. The greatest impact on symptoms is observed with the control of the triggering factor and if it persists, pharmacological therapy provides good results. Conclusion: Myoclonus are relatively common movement disorders in chronic kidney disease. Identification of the trigger is crucial for its management along with the use of drugs with anti-myoclonic activity.

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Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction; however, its use is associated with fasciculation and myalgia. We performed a systematic review and meta-analysis of randomized controlled clinical trials comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included with a total of 481 patients - 241 in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR = 0.69, 95% CI 0.56-0.84, P < .001), which remained statistically significant for pregabalin (RR = 0.71, 95% CI 0.54-0.93, P = .013) and gabapentin (RR = 0.61, 95% CI 0.45-0.82, P = .001) separately. There was no difference in fasciculations between the groups (RR = 0.92, 95% CI 0.82-1.03, P = .148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24 h of surgery.

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Abstract Background Chronic low back pain (CLBP) is a global health problem, and gabapentin and pregabalin are often used in the treatment of patients without associated radiculopathy or neuropathy. Therefore, determining their efficacy and safety is of enormous value. Objective To examine the efficacy and safety of using gabapentin and pregabalin for CLBP without radiculopathy or neuropathy. Methods We performed a search on the CENTRAL, MEDLINE, EMBASE, LILACS, and Web of Science data bases for clinical trials, cohorts, and case-control studies that evaluated patients with CLBP without radiculopathy or neuropathy for at least eight weeks. The data were extracted and inserted into a previously-prepared Microsoft Excel spreadsheet; the outcomes were evaluated using the Cochrane RoB 2 tool, and the quality of evidence, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Of the 2,230 articles identified, only 5 were included, totaling 242 participants. In them, pregabalin was slightly less efficacious than amitriptyline, the combination of tramadol/acetaminophen, and celecoxib, and pregabalin added to celecoxib showed no benefit when compared to celecoxib alone (very low evidence for all). On the other hand, although one study with gabapentin did not support its use in a general sample of patients with low back pain, another found a reduction in the pain scale and improved mobility (moderate evidence). No serious adverse events were observed in any of the studies. Conclusion Quality information to support the use of pregabalin or gabapentin in the treatment of CLBP without radiculopathy or neuropathy is lacking, although results may suggest gabapentin as a viable option. More data is needed to fill this current gap in knowledge.

Resumo Antecedentes Dor lombar crônica (DLC) é um problema de saúde global, e a gabapentina e a pregabalina são frequentemente utilizadas no tratamento de pacientes sem radiculopatia ou neuropatia associada. Por isso, determinar sua eficácia e segurança é de enorme valor. Objetivo Examinar a eficácia e segurança do uso de gabapentina e pregabalina no tratamento da DLC sem radiculopatia ou neuropatia. Métodos Realizamos uma pesquisa nas bases de dados CENTRAL, MEDLINE, EMBASE, LILACS e Web of Science por ensaios clínicos, coortes e estudos de caso e controle que avaliassem pacientes com DLC sem radiculopatia ou neuropatia por pelo menos oito semanas. Os dados foram extraídos e inseridos em uma planilha previamente elaborada no programa Microsoft Excel; os desfechos foram avaliados com a ferramenta RoB 2 tool da Cochrane, e a qualidade das evidências, pelo sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados Dos 2.230 artigos identificados, apenas 5 foram incluídos, com um total de 242 participantes. Neles, a pregabalina foi ligeiramente menos eficaz do que a amitriptilina, a combinação de tramadol/acetaminofeno, e o celecoxibe, assim como a pregabalina adicionada ao celecoxibe não mostrou benefício em comparação ao uso isolado de celecoxibe (evidência muito baixa para todos). Quanto à gabapentina, embora um estudo não respalde seu uso para uma amostra geral de pacientes com lombalgia, outro encontrou redução na escala de dor e melhora da mobilidade (evidência moderada). Nenhum evento adverso grave foi observado nos estudos. Conclusão Há carência de informações de qualidade que sustentem o uso de pregabalina ou gabapentina no tratamento da DLC sem radiculopatia ou neuropatia, embora resultados possam sugerir que a gabapentina é uma opção viável. Mais dados são necessários para preencher essa atual lacuna no conhecimento.

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Abstract Objective: To evaluate the effect of neuromodulatory drugs on the intensity of chronic pelvic pain (CPP) in women. Data sources: Searches were carried out in the PubMed, Cochrane Central, Embase, Lilacs, OpenGrey, and Clinical Trials databases. Selection of studies: The searches were carried out by two of the authors, not delimiting publication date or original language. The following descriptors were used: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors, and tricyclic antidepressants, with the Boolean operator OR. Case reports and systematic reviews were excluded. Data collection: The following data were extracted: author, year of publication, setting, type of study, sample size, intervention details, follow-up time, and results. Data synthesis: A total of 218 articles were found, with 79 being excluded because they were repeated, leaving 139 articles for analysis: 90 were excluded in the analysis of the titles, 37 after reading the abstract, and 4 after reading the articles in full, and 1 could not be found, therefore, leaving 7 articles that were included in the review. Conclusion: Most of the studies analyzed have shown pain improvement with the help of neuromodulators for chronic pain. However, no improvement was found in the study with the highest statistical power. There is still not enough evidence that neuromodulatory drugs reduce the intensity of pain in women with CPP.

Resumo Objetivo: Avaliar o efeito de drogas neuromoduladoras na intensidade da dor pélvica crônica em mulheres. Fontes de dados: As buscas foram realizadas nas bases de dados PubMed, Cochrane Central, Embase, Lilacs, OpenGrey e Clinical Trials. Seleção dos estudos: As buscas foram realizadas por dois dos autores, não delimitando data de publicação ou idioma de publicação. Foram usados os seguintes descritores: chronic pelvic pain in women OR endometriosis, associated with MESH/ENTREE/DeCS: gabapentinoids, gabapentin, amitriptyline, antidepressant, pregabalin, anticonvulsant, sertraline, duloxetine, nortriptyline, citalopram, imipramine, venlafaxine, neuromodulation drugs, acyclic pelvic pain, serotonin, noradrenaline reuptake inhibitors e tricyclic antidepressants, com o operador booleano OR. Relatos de caso e revisões sistemáticas foram excluídos. Coleta de dados: Foram extraídos os seguintes dados: autor, ano de publicação, local de origem, tipo de estudo, tamanho da amostra, detalhes da intervenção, tempo de seguimento e resultados. Síntese dos dados: Foram encontrados 218 artigos, sendo 79 deles excluídos por serem repetidos, restando 139 artigos para análise, dos quais 90 foram excluídos na análise dos títulos, 37 após a leitura do resumo e 4 após a leitura dos artigos na íntegra, e 1 não foi encontrado, restando, então, 7 artigos que foram incluídos na revisão. Conclusão: A maioria dos estudos analisados mostrou melhora da dor crônica com auxílio de neuromoduladores. No entanto, nenhuma melhora foi encontrada no artigo com maior poder estatístico. Ainda não há evidências suficientes de que drogas neuromoduladoras reduzam a intensidade da dor pélvica crônica em mulheres.

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ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.

RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.

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Abstract The study reviews the suitability of using Gabapentin for treating opioid, cannabis and methamphetamine use disorders. This revision consists of 61 biographical references based on a PubMed database search (January of 1983-May of 2018). Gabapentin displayed respectively 50% and 66.7% of success for treating methamphetamine dependence and opioid withdrawal symptoms. Furthermore, a few research studies have reported Gabapentin's efficacy for alleviating cannabis dependence (two studies), and cannabis withdrawal symptoms (one study). Similarly, a single study reported Gabapentin reduction of opioid consumption during the detoxification process. Based on the revision, we can conclude that: (a) Gabapentin is useful for treating opioid withdrawal symptoms, (b) additional studies are necessary for elucidating the effectiveness of Gabapentin for treating methamphetamine dependence, cannabis dependence and its withdrawal symptoms, and (c) more studies are necessary to confirm the efficacy of Gabapentin in reducing opioid consumption during detoxification.

Resumen El trabajo revisa 61 referencias bibliográficas, producto de una búsqueda en la base de datos PubMed (enero de 1983 a mayo de 2018), con el fin de determinar si la Gabapentina es adecuada para el tratamiento de trastornos derivados del uso de opiáceos, cannabis y metanfetaminas. El éxito de la Gabapentina para tratar la dependencia a las metanfetaminas y los síntomas de abstinencia de opiáceos fue de 50% y 66.7%, respectivamente. Algunas investigaciones han informado la eficacia de la Gabapentina para aliviar la dependencia al cannabis (dos estudios) y los síntomas de abstinencia del cannabis (un estudio). Un solo estudio reportó que la Gabapentina redujo el consumo de opiáceos, durante el proceso de desintoxicación. La revisión nos permite concluir que (a) la Gabapentina es útil para tratar los síntomas de abstinencia de los opiáceos, (b) se necesitan más estudios para esclarecer la efectividad de la Gabapentina para tratar la dependencia a las metan-fetaminas, al cannabis y los síntomas de abstinencia, y (c) se requieren más estudios para confirmar la eficacia de la Gabapentina para reducir el consumo de opiáceos durante la desintoxicación.

Resumo A partir de uma busca na base de dados PubMed (janeiro de 1983 a maio de 2018), são revisadas 61 referências bibliográficas a fim de determinar se a gabapentina é adequada para tratar transtornos derivados do uso de opiáceos, cannabis e metanfetaminas. O sucesso do uso da gabapentina para tratar a dependência das metanfetaminas e dos sintomas de abstinência de opiáceos foi de 50% e 66,7%, respectivamente. Algumas pesquisas relatam a eficácia da gabapentina para aliviar a dependência de cannabis (dois estudos) e dos sintomas de abstinência de cannabis (um estudo). Somente um estudo relatou que a gabapentina reduzia o consumo de opiáceos durante o processo de desintoxicação. A revisão nos permite concluir que: (a) a gabapentina é útil para tratar os sintomas de abstinência dos opiáceos, (b) é necessário mais estudos para esclarecer a efetividade da gabapentina para tratar a dependência das metanfetaminas, da cannabis e dos sintomas de abstinência e (c) são necessários mais estudos para confirmar a eficácia da gabapentina para reduzir o consumo de opiáceos durante a desintoxicação.

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Abstract: Objective: To assess the efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery. Material and methods: A PRISMA-compliant systematic review and meta-analysis was conducted in PubMed, Cochrane Library and ScienceDirect databases. Randomized Controlled Trials (RCTs) comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing shoulder arthroscopic surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score at 24 hours and cumulative morphine consumption at 24 hours. The secondary outcomes were complications of nausea/vomiting, sedation and dizziness. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. Results: Five clinical studies (gabapentin group n = 4 and pregabalin group n = 1) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 24 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea/vomiting. There were no significant differences in the occurrence of sedation and dizziness. Conclusions: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following arthroscopic shoulder surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after shoulder surgery.

Resumen: Objetivo: Evaluar la eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica del hombro. Material y métodos: Se llevó a cabo una revisión sistemática y metaanálisis conforme a PRISMA en las bases de datos PubMed, Cochrane Library y ScienceDirect. Se recuperaron ensayos controlados aleatorios (RCT) que comparaban los gabapentinoides (gabapentina y pregabalina) con placebo en pacientes sometidos a cirugía artroscópica del hombro. El punto final principal fue la puntuación de la escala analógica visual (VAS) a las 24 horas y el consumo acumulado de morfina a las 24 horas. Los resultados secundarios fueron complicaciones de náuseas/vómitos, sedación y mareos. Después de realizar pruebas de sesgo de publicación y heterogeneidad entre los estudios, se agregaron datos para modelos de efectos aleatorios cuando fue necesario. Resultados: En última instancia, se incluyeron en el metaanálisis cinco estudios clínicos (grupo de gabapentina n = 4 y grupo de pregabalina n = 1). Los gabapentinoides se asociaron con puntuaciones de dolor reducidas a las 24 horas. Del mismo modo, los gabapentinoides se asociaron con una reducción en el consumo acumulado de morfina a las 24 horas. Además, los gabapentinoides pueden reducir significativamente la aparición de náuseas/vómitos. No hubo diferencias significativas en la ocurrencia de sedación y mareos. Conclusiones: El uso preoperatorio de gabapentinoides fue capaz de reducir el dolor postoperatorio, el consumo total de morfina y las complicaciones relacionadas con la morfina después de la cirugía artroscópica del hombro. Otros estudios deben determinar la dosis óptima y si la pregabalina es superior a la gabapentina en el control del dolor agudo después de la cirugía de hombro.

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RESUMEN La posibilidad de usar el oxihidróxido del cobalto en la detección electroquímica de la gabapentina ha sido evaluada, y se sugirió un mecanismo del desempeño del analito y del modificador. Este fue desarrollado y analizado (mediante la teoría de estabilidad lineal y análisis de bifurcaciones) un modelo matemático basado en este mecanismo. La evaluación teórica confirma que el oxihidróxido de cobalto puede ser un modificador eficiente para la detección de la gabapentina, a pesar de la hibridez de su mecanismo de oxidación. La posibilidad y las causas de los comportamientos oscilatorio y monotónico también han sido investigadas.

SUMMARY The possibility for the use of cobalt (III) oxyhydroxide in gabapentine electrochemical determination has been evaluated. A mechanism for analyte and modifier function has been suggested. A mathematical model based in this mechanism has been developed and analyzed (by means of linear stability theory and bifurcation analysis). The theoretical evaluation confirms that the cobalt (III) oxyhydroxide may be an efficient modifier for gabapentine electrochemical determination, despite of the hybridity of its oxidation mechanism. The possibility and the causes for oscillatory and monotonic instabilities have also been investigated.

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Abstract Background and objectives: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. Methods: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3 mg and gabapentin 900 mg orally, group 2 received matching placebo capsule and gabapentin 900 mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. Results: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p = 0.002, p = 0.003, p = 0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p = 0.002, p = 0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p = 0.0566). Conclusions: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

Resumo Justificativa e objetivos: Gabapentina é um agente antiepiléptico, amplamente utilizado para o tratamento da dor neuropática. Embora conhecida por ser bem-tolerada, sonolência e tontura são os seus efeitos adversos mais frequentes. Neste estudo, nosso objetivo foi avaliar o efeito da melatonina sobre o efeito colateral de sonolência diurna da gabapentina, a qualidade do sono e a intensidade da dor em pacientes com dor neuropática. Métodos: Os pacientes que sofriam de "dor neuropática" e com prescrição para receber terapia com gabapentina foram divididos aleatoriamente em dois grupos. O Grupo 1 recebeu 3 mg de melatonina e 900 mg de gabapentina por via oral, o Grupo 2 recebeu uma cápsula de placebo correspondente e 900 mg de gabapentina. A escala de sonolência de Epworth (ESS), o índice de qualidade do sono de Pittsburgh para avaliação da qualidade do sono (PSQI) e a escala de avaliação verbal (VRS) foram aplicados nos dias 0, 10 e 30 de tratamento. A necessidade de medicamentos analgésicos adicionais foi registrada. Resultados: Oitenta pacientes foram incluídos no estudo; idade, sexo, quantidade de analgésico adicional consumida e os escores basais de ESS, PSQI e VRS foram semelhantes entre os grupos. Os escores ESS, PSQI e VRS do Grupo 1 foram significativamente menores que os do Grupo 2 no décimo dia de tratamento (p = 0,002, p = 0,003, p = 0,002, respectivamente). No trigésimo dia de tratamento, os escores ESS e VRS foram significativamente menores no Grupo 1 (p = 0,002, p = 0,008, respectivamente). No entanto, os escores PSQI não diferiram significativamente entre os grupos (p = 0,0566). Conclusões: A suplementação de melatonina melhorou de forma rápida e significativa o efeito colateral de sonolência diurna da gabapentina, mas a qualidade do sono dos pacientes com dor neuropática foi semelhante entre os grupos.

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BACKGROUND AND OBJECTIVES: Gabapentin is an antiepileptic drug. Widely used for the management of neuropathic pain. Although it is known to be well tolerated, somnolence and dizziness are the most frequent adverse effects. In this study, we aimed to evaluate the effect of melatonin on daytime sleepiness side effect of gabapentin, sleep quality and pain intensity of patients with neuropathic pain. METHODS: Patients suffering from "neuropathic pain" and planed to receive gabapentin therapy were randomly divided into two groups. Group 1 received melatonin 3mg and gabapentin 900mg orally, group 2 received matching placebo capsule and gabapentin 900mg. The Epworth Sleepiness Scale, the Pittsburgh sleep quality index for assessment of sleep quality and Verbal Rating Scale were completed at the 0th, 10th and 30th days of treatment. Additive analgesic drug requirements were recorded. RESULTS: Eighty patients were enrolled to the study; age, gender, ratio of additive analgesic consumption, baseline Epworth Sleepiness Scale, Pittsburg Sleep Quality index and Verbal Rating Scale scores were similar between the groups. Epworth Sleepiness Scale scores, Pittsburgh sleep quality index scores and Verbal Rating Scale scores in Group 1 were significantly lower than group 2 at the 10th day of treatment (p=0.002, p=0.003, p=0.002 respectively). At the 30th day of treatment, Epworth Sleepiness Scale scores and Verbal Rating Scale scores were significantly lower in Group 1 (p=0.002, p=0.008 respectively). However, Pittsburgh sleep quality index scores did not significantly differ between the groups (p=0.0566). CONCLUSIONS: Melatonin supplementation rapidly and significantly improved daytime sleepiness side-effect of gabapentin, however sleep quality of the patients with neuropathic pain was similar between groups.

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Objective: Observe the behavior of gabapentin to reduce reactive hypertension secondary to anxiety and pain in patients undergoing ophthalmic surgery as well as opioid consumption between groups. Method: Clinical randomized double blind controlled trial that analyzed 125 patients divided into three groups: Group A, gabapentin 300 mg; Group B, gabapentin 450 mg; and Group C, amaranth dragees as a control 2 h before the surgical procedure. Chi-squared test was used in sociodemographic variables and one-way ANOVA for continuous numeric variables. It was considered as significant a p < 0.05 for a study of two tails with a power of 80% beta. Results: Anxiety and analgesia intraoperative and postoperative had significant differences between groups. Lower consumption of opioid was found in the groups that used gabapentin. Conclusions: Gabapentin orally 300 or 450 mg h prior to surgery reduces pain, anxiety and postoperative opioid consumption in patients undergoing ophthalmic surgery.

Objetivo: Observar el comportamiento de la gabapentina para aminorar la hipertensión reactiva secundaria a ansiedad y dolor en pacientes sometidos a cirugía oftálmica, así como el consumo de opiáceos entre los grupos. Método: Ensayo clínico controlado aleatorizado y doble ciego que analizó a 125 pacientes divididos en tres grupos: grupo A, gabapentina 300 mg; grupo B, gabapentina 450 mg; grupo C, amaranto en grageas como control 2 horas antes del procedimiento quirúrgico. Se utilizó la prueba de ji al cuadrado para variables sociodemográficas y ANOVA de un factor para variables numéricas continuas. Se consideró como significativo un valor de p < 0.05 para un estudio de dos colas con un poder beta del 80%. Resultados: La ansiedad y la analgesia transoperatoria y posoperatoria tuvieron diferencias significativas entre los grupos. Se encontró menor consumo de opiáceos en los grupos que usaron gabapentina. Conclusiones: La gabapentina por vía oral, 300 o 450 mg, 2 horas antes de la cirugía, reduce el dolor, la ansiedad y el consumo de opiáceos durante el posoperatorio en pacientes sometidos a cirugía oftalmológica.

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Abstract Objectives: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery. Methods: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review. Results: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications. Conclusion: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.

Resumo Objetivos: A esternotomia para cirurgias cardíacas causa dor intensa no pós-operatório e quando não tratada adequadamente pode causar morbidade grave. Como nesse caso a dor neuropática é uma componente importante, gabapentina e pregabalina podem ser eficazes nesses pacientes e podem reduzir o consumo de opioides no pós-operatório. O objetivo desta revisão sistemática foi avaliar a eficácia de gabapentina e pregabalina na dor aguda após cirurgia cardíaca. Métodos: Foram incluídos nesta revisão estudos clínicos prospectivos e randômicos com humanos, que compararam o uso de gabapentina/pregabalina nos períodos pré- e/ou pós-operatório com placebo ou nenhum tratamento para o controle da dor no pós-operatório de cirurgia cardíaca. Resultados: Quatro ECRs de gabapentina e pregabalina foram incluídos nesta revisão sistemática. Três estudos de gabapentina e dois de pregabalina relataram diminuição do consumo de opioides em pacientes cirúrgicos cardíacos; um estudo de gabapentina e dois de pregabalina não relataram. Três ECRs de gabapentina e pregabalina relataram escores menores de dor, durante a atividade e o repouso. Os medicamentos não estão associados a complicações significativas. Conclusão: Embora os escores de dor tenham sido menores no pós-operatório, não há evidências suficientes para recomendar o uso rotineiro de gabapentina e pregabalina para reduzir o consumo de opioides em pacientes cirúrgicos cardíacos.

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OBJECTIVES: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery. METHODS: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review. RESULTS: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications. CONCLUSION: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.

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Abstract Aim: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. Method: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2 h before the operation were given oral capsules of placebo (Group P, n = 25), 400 mg gabapentin (Group G400, n = 25), 800 mg gabapentin (Group G800, n = 25) or 1200 mg gabapentin (Group G1200, n = 25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3 mg kg−1 etomidate was administered for 10 s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2 µg kg−1 fentanyl and 0.8 mg kg−1 rocuronium were administered for tracheal intubation. Results: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. Conclusion: Pretreatment with 800 mg and 1200 mg gabapentin 2 h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

Resumo Objetivo: Avaliar os efeitos de três doses diferentes de gabapentina como pré-tratamento sobre a incidência e a gravidade dos movimentos mioclônicos associados à injeção de etomidato. Método: Cem pacientes, entre 18-60 anos, estado físico ASA I-II, programados para cirurgia eletiva sob anestesia geral, foram incluídos no estudo. Os pacientes foram randomicamente divididos em quatro grupos e duas horas antes da operação receberam cápsulas orais de placebo (Grupo P, n = 25), 400 mg de gabapentina (Grupo G400, n = 25), 800 mg de gabapentina (Grupo G800, n = 25) e 1.200 mg de gabapentina (Grupo G1.200, n = 25). Os efeitos colaterais antes da cirurgia foram registados. Após pré-oxigenação para a indução da anestesia, etomidate (0,3 mg.kg−1) foi administrado por 10 segundos. Um único anestesista, cego para a medicação do estudo, avaliou a sedação e os movimentos mioclônicos com uma escala de 0 a 3. Dois minutos após a indução, fentanil (2 µgr.kg−1) e rocurônio (0,8 mg.kg−1) foram administrados para a intubação traqueal. Resultados: Os dados demográficos foram semelhantes. A incidência e a gravidade da mioclonia nos grupos G1.200 e G800 foram significativamente menores do que no Grupo P; a incidência e o nível de sedação foram consideravelmente maiores comparados com o Grupo P e o Grupo G400. Enquanto não houve diferença na incidência de mioclonia entre os grupos P e G400, a gravidade da mioclonia no Grupo G400 foi menor do que no grupo placebo. No período de duas horas antes da indução, nenhum dos efeitos colaterais relacionados à gabapentina, exceto sedação, foi observado em qualquer paciente. Conclusão: O pré-tratamento com 800 mg e 1.200 mg de gabapentina duas horas antes da operação aumentou o nível de sedação e reduziu a incidência e a gravidade dos movimentos mioclônicos associados ao etomidato.

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AIM: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. METHOD: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2µgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation. RESULTS: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. CONCLUSION: Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

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AIM: To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. METHOD: One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2µgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation. RESULTS: Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. CONCLUSION: Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.

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INTRODUCTION: Pain is a common symptom in patients with Guillain-Barre syndrome. Intensity is moderate to severe in most cases and pain may persist after resolution of the disease. OBJECTIVE: Identify the most appropriate analgesic therapy for pain management in patients with Guillain-Barre syndrome. MATERIAL AND METHODS: Systematic review and selection of scientific articles on treatment of pain in Guillain-Barre syndrome patients, published between January 1985 and December 2012. We included only randomised, double-blind, controlled trials assessing the effectiveness of drugs for pain management in these patients. RESULTS: Four articles met the inclusion criteria. One evaluated the use of gabapentin, another evaluated carbamazepine, a third compared gabapentin to carbamazepine, and the last evaluated use of methylprednisolone. Both carbamazepine and gabapentin were useful for pain management. Patients experienced lower-intensity pain with gabapentin treatment in the study comparing that drug to carbamazepine. Methylprednisolone was not shown to be effective for reducing pain. The published data did not permit completion of a meta-analysis. CONCLUSIONS: There is no robust evidence at present that would point to a single treatment option for this disorder. Further clinical studies of larger patient samples and with a longer duration are needed to characterise types of pain for each patient and measure pain intensity in an objective way.

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OBJECTIVE: Prevention and treatment ofpostoperative pain and operation complications such as nausea and vomiting are most important concerns in postoperative care. There are several mechanisms involved in postoperative pain. Gabapentin is a gamma aminobutyric acid analogue that is known as an anticonvulsant drug. This drug is tolerated well and has known effects on pain and anxiety. This study has compared the effect of gabapentin on postoperative pain, operation complications and haemodynamics. SUBJECTS AND METHODS: This randomized double blinded placebo controlled clinical trial was conducted on 61 patients divided randomly into two groups (30 as cases and 31 as controls). All patients had total abdominal hysterectomy. In the first group, the patients got 100 mg gabapentin in the night and 300 mg gabapentin orally (one capsule) two hours before surgery. The second group got one capsule of multivitamin orally. Then all patients were subjected to the same anaesthesia protocol and total abdominal hysterectomy. During the 24 hours after operation, the patients were assessed according to pain, nausea, vomiting, dizziness, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and morphine use at 1, 6, 12 and 24 hours. RESULTS: Mean age and weight of patients were 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 and 68.8 ± 12.88 in the study population and control groups, respectively. Except in the first hour after operation (p = 0.02), there was no significant differences between the two groups in morphine use. There was no significant correlation between the groups according to postoperative complications and the haemo-dynamic parameters (PR, SBP and DBP). CONCLUSION: Results show that gabapentin can decrease the need for morphine use in the first hour after operation only and has no significant effect on operation complications. Thus, we suggest gabapentin for pain management, and not to decrease opium use.

OBJETIVO: La prevención y tratamiento de dolor postoperatorio y las complicaciones de la operación -tales como la náusea y el vómito - son problemas de suma importancia en el cuidado postoperatorio. Hay varios mecanismos implicados en el dolor postoperatorio. La gabapentina es un análogo del ácido gamma-aminobutírico, conocido como un medicamento anticonvulsivo. Este medicamento es bien tolerado, y tiene efectos conocidos sobre el dolor y la ansiedad. El presente estudio compara el efecto de la gabapentina sobre el dolor postoperatorio, las complicaciones de la operación, y la hemo-dinámica. SUJETOS Y MÉTODOS: Este ensayo clínico, aleatorio, doble ciego y controlado con placebo, se llevó a cabo con 61 pacientes divididos aleatoriamente en dos grupos (30 como casos y 31 como control). Todas las pacientes tuvieron histerectomia abdominal total. En el primer grupo, las pacientes recibieron via oral 100 mg de gabapentina por la noche y 300 mg de gabapentina (una cápsula) dos horas antes de la cirugía. El segundo grupo recibió una cápsula de multivitaminas por vía oral. Luego, todas las pacientes fueron sometidas al mismo protocolo de anestesia e histerectomía abdominal total. Durante las 24 horas después de la operación, las pacientes fueron evaluadas en relación con dolores, náusea, vómitos, vértigo, presión sanguínea sistólica (PSS), presión sanguínea diastólica (PSD), frecuencia de pulso (FP), y el uso de morfina a la 1, 6, 12 y 24 horas. RESULTADOS: La edad promedio y el peso de las pacientes fue 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 y 68.8 ± 12.88 en la población de estudio y los grupos de control, respectivamente. Excepto en la primera hora tras la operación (p = 0.02), no hubo ninguna diferencia significativa entre los dos grupos en cuanto al uso de morfina. No hubo correlación significativa alguna entre los grupos sobre la base de las complicaciones postoperatorias y los parámetros hemodinámicos (FP, PSS, y PSD). CONCLUSIÓN: Los resultados muestran que la gabapentina sólo puede disminuir la necesidad del uso de morfina en la primera hora tras la operación, y no tiene efectos significativos en las complicaciones de la operación. Por lo tanto, se sugiere el uso de la gabapentina para el tratamiento del dolor, pero no para reducir el uso del opio.

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La prevalencia de neuropatía periférica dolorosa en pacientes diabéticos es de aproximadamente 16%. Esta condición clínica afecta de manera importante la calidad de vida de los pacientes. Además, se conoce que la adherencia de los pacientes es menor para fármacos que alivian el dolor, en relación a antidiabéticos orales. Los factores más relevantes para esto son el costo de los medicamentos, el potencial benefcio que se podría obtener con su administración y estados emocionales como la depresión, este último asociado también al no consumo de antidiabéticos orales [1, 2]. Las alternativas farmacológicas de primera línea contra el dolor de la neuropatía diabética periférica incluyen los antidepresivos tricíclicos (como amitriptilina), inhibidores selectivos de la recaptación de serotonina y noradrenalina (duloxetina) y los anticonvulsivantes gabapentina y pregabalina [1]. De estos fármacos, la amitriptilina ha sido una alternativa tradicional y los otros son opciones más modernas. En este contexto, se formuló en formato PICO (paciente ­ intervención ­ comparación ­ resultados) la siguiente pregunta: ¿En pacientes con neuropatía diabética periférica dolorosa, el uso de amitriptilina en relación con gabapentina, pregabalina y duloxetina; controla adecuadamente el dolor?

The prevalence of painful peripheral neuropathy in diabetic patients is of approximately 16%. This clinical condition significantly affects the quality of life of patients. In addition, it is known that adhesion of patients is less for drugs that relieve pain, in relation to oral antidiabetics The most relevant factors for this are the cost of medications, the potential benefit that could be obtained with its administration and emotional states such as depression, the latter associated also to the non-consumption of oral antidiabetics. The first line pharmacological alternatives against the pain of neuropathy Peripheral diabetics include tricyclic antidepressants (such as amitriptyline), selective serotonin and norepinephrine reuptake inhibitors (duloxetine) and Gabapentin and pregabalin anticonvulsants. Of these drugs, amitriptyline It has been a traditional alternative and the others are more modern options. In this context, the following question was asked in PICO format (patient - intervention - comparison - results): In patients with painful peripheral diabetic neuropathy, the use of amitriptyline in relation to gabapentin, pregabalin and duloxetine; properly control pain?

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JUSTIFICATIVA E OBJETIVOS: Caracterizada principalmente como uma doença da pele e nervos, a hanseníase ainda é um importante problema de saúde pública por manter-se endêmica em grande parte do território nacional e pelo seu potencial de causar lesões irreversíveis de nervos periféricos e incapacidades físicas.RELATOS DOS CASOS: Caso 1: Paciente do sexo masculino, 40 anos, portador de hanseníase desde 2006, reação tipo II multibacilar, após um ano iniciou com dores em queimação nos membros superiores acompanhado de eritema nodoso e neurite com espessamento no nervo ulnar bilateral. Foi tratado para dor neuropática com gabapentina, codeína e amitriptilina. Houve redução da dor pela escala analógica visual (EAV) de 10 para 4. Caso 2: Paciente do sexo masculino, 59 anos, portador de hanseníase desde 2002, reação tipo II multibacilar, apresentando dor tipo queimação nos pés desde 2003. Foi tratado com codeína, amitriptilina e gabapentina. Houve redução da EAV inicial de 10 para 3. Caso 3: Paciente do sexo feminino, 42 anos, portadora de hanseníase desde 2007, reação tipo I multibacilar, iniciou com parestesias e dores tipo queimação membros inferiores associadas à redução de força muscular. Realizou biopsia nervo sural com resultado de neurite inflamatória e desmielinização axonal. Foi tratada com gabapentina, codeína e amitriptilina. Houve redução da EAV inicial de 10 para 4. Caso 4: Paciente do sexo masculino, 40 anos, portador de hanseníase há 10 anos, reação tipo I multibacilar, apresentando dores tipo queimação e choque com parestesias nos membros superiores e inferiores há 8 anos. Em uso de carbamazepina, codeína e paracetamol. Houve redução da EAV inicial de 10 para 2. CONCLUSÃO: A lesão neural está especialmente relacionada ao diagnóstico tardio da doença e ao manuseio terapêutico inadequado das neurites e reações hansênicas.

BACKGROUND AND OBJECTIVES: Mainly characterized as a skin and nerves disease, Hanseniasis is still a major public health problem for being endemic in a large part of Brazil and for its potential to induce irreversible peripheral nerves injury and physical disability.CASE REPORTS: Case 1: Male patient, 40 years old, with Hanseniasis since 2006, multibacillar reaction type II. One year after he started with burning pain in upper limbs, followed by nodous erythema and neuritis with bilateral thickening of ulnar nerve. He was treated for neuropathic pain with gabapentin, codein and amitriptyline. There has been pain decrease according to visual analog scale (VAS) from 10 to 4. Case 2: Male patient, 59 years old, with Hanseniasis since 2002, multibacillar reaction type II, with burning pain in feet since 2003. Patient was treated with codein, amitriptyline and gabapentin. There has been initial VAS decrease from 10 to 3. Case 3: Female patient, 42 years old, with Hanseniasis since 2007, multibacillar reaction type I. Patient started with paresthesias and burning pain in lower limbs associated to decreased muscle strength. Sural nerve was biopsed with result of inflammatory neuritis and axonal demyelination. Patient was treated with gabapentin, codein and amitriptyline. There has been initial VAS decrease from 10 to 4. Case 4: Male patient, 40 years old, with Hanseniasis for 10 years, multibacillar reaction type I, with burning and shock pain and upper and lower limbs paresthesia for 8 years. Patient was treated with carbamazepine, codein and paracetamol. There has been initial VAS decrease from 10 to 2. CONCLUSION: Neural injury is especially related to late disease diagnosis and to inadequate therapeutic management of neuritis and Hansen's disease reactions.