RESUMO
Dipyrone is a commonly used analgesic in many countries and there is limited data on its possible endocrine disrupting effects. We performed a screening for in vivo and in vitro anti(estrogenic) activity of dipyrone. For the in vivo uterotrophic assay, immature female rats (22-days-old) were treated daily by oral gavage for three days with different doses of dipyrone alone (50, 100, 200 mg/kg/day) and associated with three ethynylestradiol (EE) doses (1, 3 and 10 µg/kg/day), which were based on a dose-response curve experiment. The uterine weight was used as a biomarker for estrogenicity. In a parallel in vitro approach, we used a yeast-based transcriptional activation reporter gene assay (Yeast Estrogen Screening - YES) for assessment of estrogenic agonistic and antagonistic effects of dipyrone and its main metabolites 4-methylaminoantipyrine (MAA) and 4-aminoantipyrine (AA). In the uterotrophic assay, animals that received EE at 1, 3 and 10 µg/kg/day showed an increase in relative uterine weight compared with vehicle-only rats (canola oil). Dipyrone did not increase uterine weight at any dose tested (50, 100 and 200 mg/kg/day) in relation to vehicle control, indicating absence of estrogenic activity. Furthermore, co-administration of dipyrone (50 and 200 mg/kg/day) and EE (1, 3 or 10 µg/kg/day) was unable to block EE estrogenic action in comparison to the groups treated with EE alone, indicating absence of antiestrogenic activity. In the YES assay dipyrone and its metabolites did not demonstrate estrogen agonistic or antagonistic properties in the yeast cells. These results suggest that dipyrone and its metabolites do not produce (anti)estrogenic effects in vivo or in vitro.
Assuntos
Anti-Inflamatórios não Esteroides/toxicidade , Dipirona/toxicidade , Estrogênios/toxicidade , Útero/efeitos dos fármacos , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Dipirona/administração & dosagem , Relação Dose-Resposta a Droga , Estrogênios/administração & dosagem , Feminino , Ratos , Ratos Wistar , Saccharomyces cerevisiaeRESUMO
BACKGROUND: The estimated glomerular filtration rate is a rather important measurement for patients under intensive care, since they often receive several drugs, and impaired renal function may result in misleading dosing. The estimated glomerular filtration is derived from mathematical models using serum creatinine, a measurement that suffers interference of some drugs, such as metamizole. This study intended to evaluate the impact on patient stratification for dose adjustment of two antimicrobials (meropenem and vancomycin) caused by metamizole interference in creatinine measurement by dry chemistry. METHODS: A cross-sectional study was conducted with a group of 108 hospitalized patients under metamizole prescriptions at fixed intervals. Serum creatinine concentrations were determined by enzymatic dry chemistry and Jaffé assays, and the estimated glomerular filtration rate was calculated through the CKD-EPI equation. Patients were stratified in groups according to their estimated glomerular filtration rate for drug dosing of vancomycin and meropenem. RESULTS: Creatinine values were significantly lower in measurements performed by the dry chemistry method in comparison to Jaffé assay (P < 0.0001) when patients are under metamizole treatment. A significant bias (-40.3%) was observed between those two methods, leading to a significant difference (P < 0.0001) in patient classification according to renal function using the CKD-EPI equation for dosing adjustment. CONCLUSIONS: During the validity of metamizole treatment, the stratification for drug dosing by the estimated glomerular filtration rate is not reliable if the creatinine measurement is done through dry chemistry. Clinical and laboratory staff must be aware of these limitations and cooperate to optimize pharmacotherapy.
Assuntos
Creatinina/sangue , Dipirona , Taxa de Filtração Glomerular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dipirona/administração & dosagem , Dipirona/efeitos adversos , Dipirona/farmacocinética , Feminino , Humanos , Masculino , Meropeném/administração & dosagem , Meropeném/efeitos adversos , Meropeném/farmacocinética , Pessoa de Meia-Idade , Vancomicina/administração & dosagem , Vancomicina/efeitos adversos , Vancomicina/farmacocinéticaRESUMO
Dipyrone (metamizole) is well-known for its powerful effect with central and peripheral activity. This meta-analysis involved articles published between 1973 and 2021, revealing that Brazil is the country which most published scientific articles relating the use of dipyrone in dogs, and this drug is widely recommended as an analgesic to control pain in cases of postoperative and cancer. Dipyrone is one of the favorite drugs used in small animal clinic in Brazil, and 12 commercial brands are available to use in dogs at doses among 25 to 50mg/kg for oral, intravenous and intramuscular administration. The effects of dipyrone may be potentiated when used in combination with other analgesic agents such as tramadol. In several studies, the occurrence of vomiting has been observed as an adverse effect, especially when the drug is used during surgical procedures, but metamizole has presented a low potential to cause gastric ulceration. The meta-analysis study of the use of dipyrone in dogs shows the clinical importance of this drug in Brazil, being an effective and safe medication, as long as it is used in the indicated dose of 25 mg/kg.(AU)
A dipirona (metamizol) é bem conhecida por seu poderoso efeito com atividade central e periférica. Esta meta-nálise envolveu estudos publicados entre os anos de 1973 a 2021, revelando que o Brasil é o país que mais publicou artigos científicos envolvendo o uso de dipirona em cães, sendo este fármaco amplamente recomendado como analgésico para controlar a dor em casos de câncer e dor pós-operatória. É um dos medicamentos preferidos da clínica médica de pequenos animais no Brasil. 12 marcas comerciais estão disponíveis para uso em cães em doses que variam de 25 a 50g para administração oral, intravenosa e intramuscular. Os efeitos da dipirona podem ser potencializados quando usada em combinação com outros analgésicos, como o tramadol. Em vários estudos, a ocorrência de vômito tem sido observada como efeito adverso, principalmente quando o medicamento é usado durante procedimentos cirúrgicos, mas tem baixo potencial para causar ulceração gástrica. O estudo de meta-análise do uso de dipirona em cães evidencia a importância do uso clínico deste fármaco no Brasil, sendo um medicamento eficaz e seguro para cães, desde que utilizada na dose indicada de 25 mg / kg.(AU)
Assuntos
Animais , Cães , Cães/fisiologia , Dipirona/administração & dosagem , Dipirona/farmacologiaRESUMO
Dipyrone (metamizole) is well-known for its powerful effect with central and peripheral activity. This meta-analysis involved articles published between 1973 and 2021, revealing that Brazil is the country which most published scientific articles relating the use of dipyrone in dogs, and this drug is widely recommended as an analgesic to control pain in cases of postoperative and cancer. Dipyrone is one of the favorite drugs used in small animal clinic in Brazil, and 12 commercial brands are available to use in dogs at doses among 25 to 50mg/kg for oral, intravenous and intramuscular administration. The effects of dipyrone may be potentiated when used in combination with other analgesic agents such as tramadol. In several studies, the occurrence of vomiting has been observed as an adverse effect, especially when the drug is used during surgical procedures, but metamizole has presented a low potential to cause gastric ulceration. The meta-analysis study of the use of dipyrone in dogs shows the clinical importance of this drug in Brazil, being an effective and safe medication, as long as it is used in the indicated dose of 25 mg/kg.
A dipirona (metamizol) é bem conhecida por seu poderoso efeito com atividade central e periférica. Esta meta-nálise envolveu estudos publicados entre os anos de 1973 a 2021, revelando que o Brasil é o país que mais publicou artigos científicos envolvendo o uso de dipirona em cães, sendo este fármaco amplamente recomendado como analgésico para controlar a dor em casos de câncer e dor pós-operatória. É um dos medicamentos preferidos da clínica médica de pequenos animais no Brasil. 12 marcas comerciais estão disponíveis para uso em cães em doses que variam de 25 a 50g para administração oral, intravenosa e intramuscular. Os efeitos da dipirona podem ser potencializados quando usada em combinação com outros analgésicos, como o tramadol. Em vários estudos, a ocorrência de vômito tem sido observada como efeito adverso, principalmente quando o medicamento é usado durante procedimentos cirúrgicos, mas tem baixo potencial para causar ulceração gástrica. O estudo de meta-análise do uso de dipirona em cães evidencia a importância do uso clínico deste fármaco no Brasil, sendo um medicamento eficaz e seguro para cães, desde que utilizada na dose indicada de 25 mg / kg.
Assuntos
Animais , Cães , Cães/fisiologia , Dipirona/administração & dosagem , Dipirona/farmacologiaRESUMO
For ethical and organic reasons, surgical and analgesic techniques that minimize and adequately control pain should be studied. Ovariohysterectomy is the most common surgical technique in veterinary medicine and is performed in female dogs for elective or therapeutic purposes. Both conventional and minimally invasive surgical techniques are used in veterinary medicine; however, the minimally invasive laparoscopic technique is considered superior to the conventional technique because it is associated with a less painful and faster post-operative recovery. However, for various reasons, the laparoscopic technique is not yet widely used in veterinary medicine, and the conventional ovariohysterectomy is still the most common. The aim of this study, therefore, was to validate the efficacy of the combination of dipyrone, scopolamine, and meloxicam after conventional or two-port laparoscopic-assisted ovariohysterectomies in female dogs. Additionally, this study sought to assess recovery after the two surgical modalities while receiving the same analgesic protocol. Fourteen healthy adult female dogs were spayed and then evaluated using the Visual Analogue Scale, the Melbourne Scale, and the short form of the Glasgow Composite Measure Pain Scale for 72 hours after surgery. The analgesic protocol was efficient for pain control after both techniques, with minimal differences between the groups.(AU)
Devido a razões éticas e orgânicas, técnicas cirúrgicas e analgésicas que minimizam e controlam adequadamente a dor devem estudadas. A ovário-histerectomia é a técnica cirúrgica mais realizada em medicina veterinária, seja aplicada com fins eletivos ou terapêuticos. As técnicas cirúrgicas convencionais e minimamente invasivas são utilizadas em medicina veterinária, e as laparoscópicas são consideradas superiores, pois promovem menor dor e mais rápida recuperação pós-operatória. Embora esta modalidade cirúrgica seja considerada superior, por diferentes razões ainda não é tão difundida na medicina veterinária, sendo a técnica convencional de ovário-histerectomia a mais utilizada em cadelas. Por estas razões, o objetivo deste estudo foi validar a eficácia do protocolo dipirona, escopolamina e meloxicam em cadelas submetidas a ovário-histerectomia convencional ou videoassistida por dois portais, assim como avaliar a recuperação dos animais submetidos a duas modalidades cirúrgicas junto ao referido protocolo analgésico. Assim, 14 cadelas adultas saudáveis foram submetidas a ovário-histerectomia e avaliadas por meio da Escala Visual Analógica, Escala de Melbourne e Forma reduzida da Escala Composta de Glasgow até 72 horas após a realização do procedimento cirúrgico. O protocolo analgésico foi eficiente para controle da dor nos animais submetidos a ambas as técnicas cirúrgicas, e mínimas diferenças foram observadas entre os grupos.(AU)
Assuntos
Animais , Feminino , Cães , Dipirona/administração & dosagem , Dipirona/uso terapêutico , Escopolamina/administração & dosagem , Escopolamina/uso terapêutico , Meloxicam/administração & dosagem , Meloxicam/uso terapêutico , Histerectomia/veterinária , Ovário/patologia , Doenças do Cão/terapiaRESUMO
For ethical and organic reasons, surgical and analgesic techniques that minimize and adequately control pain should be studied. Ovariohysterectomy is the most common surgical technique in veterinary medicine and is performed in female dogs for elective or therapeutic purposes. Both conventional and minimally invasive surgical techniques are used in veterinary medicine; however, the minimally invasive laparoscopic technique is considered superior to the conventional technique because it is associated with a less painful and faster post-operative recovery. However, for various reasons, the laparoscopic technique is not yet widely used in veterinary medicine, and the conventional ovariohysterectomy is still the most common. The aim of this study, therefore, was to validate the efficacy of the combination of dipyrone, scopolamine, and meloxicam after conventional or two-port laparoscopic-assisted ovariohysterectomies in female dogs. Additionally, this study sought to assess recovery after the two surgical modalities while receiving the same analgesic protocol. Fourteen healthy adult female dogs were spayed and then evaluated using the Visual Analogue Scale, the Melbourne Scale, and the short form of the Glasgow Composite Measure Pain Scale for 72 hours after surgery. The analgesic protocol was efficient for pain control after both techniques, with minimal differences between the groups.
Devido a razões éticas e orgânicas, técnicas cirúrgicas e analgésicas que minimizam e controlam adequadamente a dor devem estudadas. A ovário-histerectomia é a técnica cirúrgica mais realizada em medicina veterinária, seja aplicada com fins eletivos ou terapêuticos. As técnicas cirúrgicas convencionais e minimamente invasivas são utilizadas em medicina veterinária, e as laparoscópicas são consideradas superiores, pois promovem menor dor e mais rápida recuperação pós-operatória. Embora esta modalidade cirúrgica seja considerada superior, por diferentes razões ainda não é tão difundida na medicina veterinária, sendo a técnica convencional de ovário-histerectomia a mais utilizada em cadelas. Por estas razões, o objetivo deste estudo foi validar a eficácia do protocolo dipirona, escopolamina e meloxicam em cadelas submetidas a ovário-histerectomia convencional ou videoassistida por dois portais, assim como avaliar a recuperação dos animais submetidos a duas modalidades cirúrgicas junto ao referido protocolo analgésico. Assim, 14 cadelas adultas saudáveis foram submetidas a ovário-histerectomia e avaliadas por meio da Escala Visual Analógica, Escala de Melbourne e Forma reduzida da Escala Composta de Glasgow até 72 horas após a realização do procedimento cirúrgico. O protocolo analgésico foi eficiente para controle da dor nos animais submetidos a ambas as técnicas cirúrgicas, e mínimas diferenças foram observadas entre os grupos.
Assuntos
Feminino , Animais , Cães , Dipirona/administração & dosagem , Dipirona/uso terapêutico , Doenças do Cão/terapia , Escopolamina/administração & dosagem , Escopolamina/uso terapêutico , Histerectomia/veterinária , Meloxicam/administração & dosagem , Meloxicam/uso terapêutico , Ovário/patologiaRESUMO
Tagetes lucida Cav. (Asteraceae) is an ancient medicinal plant commonly used to alleviate pain. Nevertheless, scientific studies validating this property are lacking in the literature. Animal models of pain were used to evaluate the antinociceptive and anti-inflammatory activities of T. lucida essential oil (TLEO) and a bioactive metabolite. The chemical constitution and possible toxicity of the extract and the mechanism of action of ß-caryophyllene were also explored. Temporal course curves and dose-response graphics were generated using TLEO (0.1-10 mg/kg or 3.16-31.62 mg/kg) and ß-caryophyllene (3.16-10 mg/kg). Metamizole (80 mg/kg) and indomethacin (20 mg/kg) were used as reference drugs in the formalin assay and writhing test in rats and mice, respectively. The ß-caryophyllene mechanism of action was explored in the presence of naloxone (1 mg/kg), flumazenil (10 mg/kg), WAY100635 (0.16 mg/kg), or nitro-l-arginine methyl ester (L-NAME) (20 mg/kg) in the formalin test in rats. GC/MS analysis demonstrated the presence of geranyl acetate (49.89%), geraniol (7.92%), and ß-caryophyllene (6.27%). Significant and dose-dependent antinociceptive response was produced by TLEO and ß-caryophyllene without the presence of gastric damage. In conclusion, ß-caryophyllene was confirmed as a bioactive compound in the T. lucida analgesic properties by involving the participation of receptors like opioids, benzodiazepines, and Serotonin 1A receptor (5-HT1A), as well as nitric oxide.
Assuntos
Anti-Inflamatórios/administração & dosagem , Óleos Voláteis/química , Dor/tratamento farmacológico , Sesquiterpenos Policíclicos/administração & dosagem , Tagetes/química , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Dipirona/administração & dosagem , Dipirona/farmacologia , Modelos Animais de Doenças , Cromatografia Gasosa-Espectrometria de Massas , Indometacina/administração & dosagem , Indometacina/farmacologia , Masculino , Camundongos , Óxido Nítrico/metabolismo , Dor/metabolismo , Óleos de Plantas/química , Sesquiterpenos Policíclicos/química , Sesquiterpenos Policíclicos/farmacologia , Ratos , Receptor 5-HT1A de Serotonina/metabolismoRESUMO
Background: Ovariohysterectomy (OVH) is one of the most applied techniques in Veterinary Medicine. Despite some analgesic protocols being used after this procedure in order to control post operatory pain, there is a lack of knowledge of the efficacy after conventional and two port laparoscopic-assisted techniques in dog female. Although the combined formulation of metamizol and scopolamine is used, there is no knowledge about the efficacy and collateral effects in a 6 h regimen after OVH. The aim of this research was to evaluate the efficacy of metamizol and scopolamine to analgesia after two techniques of OVH in dog female. Materials, Methods & Results: Fifteen adults and healthy dog female were submitted to OVH, being eight to the conventional procedure and seven to video assisted technic with two ports. The patients received a combination of metamizol and scopolamine, 6-6 h during 48 h and were evaluated before surgery, 60 min after extubation and on 1 h interval during the f irst 8 h, and at 12, 18, 24, 36, 48 and 72 h after surgery. For this, the University of Melbourne Pain Scale (UMPS) and the short-form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were applied by three evaluators blinded to surgical technic. Glucoses measurement was realized at 1, 6, 12, 24, 48 and 72 h after surgery. Analgesic rescue was not necessary for any animal. Punctuation of UMPS in GC decreases at 8 h and at 5 h, and to GV at 12 and 24 h. Difference between groups happened at 3 h with larger average to GV; at 48 h the punctuation in GC was lager. Considering CMPS-SF to CG, higher average was observed at 1 h and decreased at 2, 3, 8 and 18. At GV highest average points was verified at 1, 2 and 3 h and decreased at 5, 8 and 18 h. Correlation was strong and positive between each two evaluators. Animals of both groups had increased average...
Assuntos
Feminino , Animais , Cães , Analgésicos/análise , Dipirona/administração & dosagem , Escopolamina/administração & dosagem , Laparoscopia/métodos , Laparoscopia/veterinária , Histerectomia/veterinária , Ovariectomia/veterináriaRESUMO
OBJECTIVES: The aim of this study was to evaluate the effects of dipyrone and tramadol, used for 5 days, on postoperative pain, hematological and biochemical parameters, and oxidative markers on erythrocytes. METHODS: Twenty-eight healthy cats underwent ovariohysterectomy and were randomly allocated to four groups (each n = 7), according to the postoperative treatment administered intravenously: control (saline 1 ml q8h), DIP1 (dipyrone 25 mg/kg q24h), DIP2 (dipyrone 25 mg/kg q12h) and DIP3 (dipyrone 25 mg/kg q8h). All animals received tramadol (2 mg/kg q8h). Pain was assessed by visual analog (VAS), multidimensional UNESP and Glasgow pain scales for cats preoperatively and at 3, 6, 12, 24, 36 and 48 h after extubation. Venous blood was collected daily for 5 days, and on day 10, to perform a complete blood count (CBC) and determine the percentage of Heinz bodies (HBs). Serum biochemistry was evaluated preoperatively and on days 5 and 10; superoxide dismutase (SOD), catalase (CAT), myeloperoxidase (MPO) and lipoperoxidation were evaluated preoperatively and on days 3, 5 and 10. RESULTS: Control cats had higher pain scores than DIP3 cats by UNESP (P = 0.0065), and DIP2 (P = 0.0035) and DIP3 cats (P = 0.0108) by VAS 3 h postoperatively. Rescue analgesia was required by two animals in the control group and one each in the DIP1 and DIP2 groups. There was no difference in SOD or CAT among groups. On day 5, MPO was more active in DIP2 than in DIP3 cats (P = 0.0274). No difference in lipoperoxidation among treatment and control cats was found. CBC remained constant and without statistical difference among groups. Control, DIP2 and DIP3 cats presented a similar percentage of HBs on day 10. Biochemical variables were similar among groups and times. CONCLUSIONS AND RELEVANCE: The administration of dipyrone in cats, when used in combination with tramadol, did not ensure better analgesia than tramadol alone. Dipyrone did not significantly affect biochemical variables and oxidative markers, despite minimal, clinically irrelevant, hematological differences between groups.
Assuntos
Analgésicos/administração & dosagem , Dipirona/administração & dosagem , Testes Hematológicos/veterinária , Histerectomia/veterinária , Manejo da Dor/veterinária , Dor Pós-Operatória/tratamento farmacológico , Tramadol/administração & dosagem , Administração Intravenosa/veterinária , Analgésicos Opioides/administração & dosagem , Animais , Gatos , Eritrócitos , Feminino , Estresse Oxidativo , Distribuição AleatóriaRESUMO
Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.
Resumo Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Automedicação/estatística & dados numéricos , Dor Crônica/tratamento farmacológico , População Urbana/estatística & dados numéricos , Brasil , Anti-Inflamatórios não Esteroides/administração & dosagem , Dipirona/administração & dosagem , Estudos Transversais , Analgésicos/administração & dosagem , Acetaminofen/administração & dosagem , Pessoa de Meia-IdadeRESUMO
RESUMO Objetivo: Avaliar o impacto de um protocolo de manejo da dor e redução do consumo de opioides no consumo geral de opioides e nos desfechos clínicos. Métodos: Estudo em centro único, quasi-experimental, retrospectivo, de coortes antes e depois. Utilizamos uma série temporal interrompida para analisar as alterações no nível e na tendência de utilização de diferentes analgésicos. Foram usadas comparações bivariadas nas coortes antes e depois, regressão logística e regressão quantílica para estimativas ajustadas. Resultados: Incluímos 988 pacientes no período pré-intervenção e 1.838 no período pós-intervenção. O consumo de fentanil teve ligeiro aumento gradual antes da intervenção (β = 16; IC95% 7 - 25; p = 0,002), porém diminuiu substancialmente em nível com a intervenção (β = - 128; IC95% -195 - -62; p = 0,001) e, a partir de então, caiu progressivamente (β = - 24; IC95% -35 - -13; p < 0,001). Houve tendência crescente de utilização de dipirona. A duração da ventilação mecânica foi significantemente menor (diferença mediana: - 1 dia; IC95% -1 - 0; p < 0,001), especialmente para pacientes mecanicamente ventilados por períodos mais longos (diferença no 50º percentil: -0,78; IC95% -1,51 - -0,05; p = 0,036; diferença no 75º percentil: -2,23; IC95% -3,47 - -0,98; p < 0,001). Conclusão: Um protocolo de manejo da dor conseguiu reduzir o consumo de fentanil na unidade de terapia intensiva. Esta estratégia se associou com menor duração da ventilação mecânica.
ABSTRACT Objective: To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes. Methods: This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates. Results: We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (β = 16; 95%CI 7 - 25; p = 0.002) but substantially decreased in level with the intervention (β = - 128; 95%CI -195 - -62; p = 0.001) and then progressively decreased (β = - 24; 95%CI -35 - -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 - -0.05; p = 0.036; 75th percentile difference: -2.23; 95%CI -3.47 - -0.98; p < 0.001). Conclusion: A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Dor/tratamento farmacológico , Cuidados Críticos/métodos , Analgésicos Opioides/administração & dosagem , Unidades de Terapia Intensiva , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo , Dipirona/administração & dosagem , Fentanila/administração & dosagem , Estudos Retrospectivos , Estudos de Coortes , Análise de Séries Temporais Interrompida , Analgésicos/administração & dosagem , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVES: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. METHOD: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. RESULTS: 416 subjects were included; 45.7% (n=190) had chronic pain, with females (72.3%; p=0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. CONCLUSIONS: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.
Assuntos
Analgésicos/administração & dosagem , Dor Crônica/tratamento farmacológico , Automedicação/estatística & dados numéricos , Acetaminofen/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Brasil , Estudos Transversais , Dipirona/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
The aim of this study was to assess whether the effectiveness of acupuncture is similar to the use of analgesics in the management of toothache. The research included 56 volunteers who were divided into 4 groups: Real Acupuncture group, Placebo Acupuncture group, Real Dipyrone group, and Placebo Dipyrone group. The interventions of the study were performed before the dental care. Inclusion criteria were toothache of pulpal origin with pain scale (Visual Analogue Scale) above 4, absence of medication for the pain, and aged over 18 years. The Real Acupuncture volunteers received a session of acupuncture using piercing needles, while volunteers from the Placebo Acupuncture group received an acupuncture session using non-piercing sham needles. Volunteers from the Real Dipyrone group received a dipyrone tablet and the Placebo Acupuncture group received a tablet with no active ingredient. Before any therapeutic intervention, we collected samples from the volunteers' saliva to analyze the salivary cortisol, the volunteers rated the intensity of their pain using VAS, and we measured their energy level by the Ryodoraku method. After 20 minutes of treatment, all the volunteers' analysis parameters were collected again. The Real Acupuncture group presented a greater reduction of VAS than the reduction obtained by the Real Dipyrone group (p<0.05). There was no statistically significant difference between the groups for the salivary cortisol and energy level variables. It can be concluded that acupuncture was more effective in reducing odontalgia than the dipyrone and that it can be an alternative for odontalgia management.
Assuntos
Analgesia por Acupuntura , Analgésicos/administração & dosagem , Dipirona/administração & dosagem , Manejo da Dor , Odontalgia/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Escala Visual Analógica , Adulto JovemRESUMO
Resumo Objetivos: Quantificar a dor dos pacientes submetidos a cirurgia de facoemulsificação sob anestesia tópica e anestesia tópica mais dipirona e avaliar se há correlação da dor com o tempo operatório, a graduação da catarta e a Energia Ultrassônica Dissipada Acumulada. Métodos: Cento e quatro olhos de 52 pacientes foram submetidos a cirurgia de catarata por facoemulsificação. Um olho foi submetido a anestesia tópica associado à sedação. O outro olho foi submetido a anestesia anterior acrescida de 1g de dipirona venosa. 15 minutos e 24 horas após a cirurgia, uma Escala Visual de Dor era respondida. Registraram-se a graduação da catarata, tempo cirúrgico, energia ultrassônica. Resultados: Dor no grupo sem dipirona 15 minutos e 24 horas apresentou decréscimo com correlação estatística significativa (p=0,004). Não houve significância estatística na redução da dor no grupo submetido à infusão de dipirona. Pacientes com cataratas de maior graduação apresentaram dor maior no pós-operatório (p=0,046). Conclusão: Ausência de redução significativa da dor com a dipirona apresentou resultados semelhantes a outros estudos. Redução da dor 24 horas após a cirurgia no grupo sem o analgésico pode ser devido à subjetividade da dor. Pacientes com cataratas de grau mais avançados apresentam dor mais intensa.
Abstract Objectives: Evaluate the effect of intraoperative endovenous administration of dipyrone on postoperative pain in patients submitted to phacoemulsification by correlating pain scores with duration of surgery and the amount of cumulative dissipated energy (CDE) delivered to the eye. Methods: The sample consisted of 104 eyes from 52 patients submitted to phacoemulsification under topic anesthesia and sedation. In each patient, one eye was treated intraoperatively with 1g dipyrone. Information was collected on cataract grade/type, duration of surgery and CDE. Postoperative pain was scored on a visual analog scale at 15 min and 24 hours. Results: Between 15 min and 24 hours, pain decreased significantly (p=0.004) among patients not treated with dipyrone, but no change was observed in patients receiving dipyrone. Caratact severity was positively associated with postoperative pain (p=0.046). Conclusion: The absence of a measurable effect of dipyrone on pain scores matched the literature. The decrease in pain scores at 24 hours among patients not treated with dipyrone may be explained by the influence of subjective psychological factors on pain perception. Higher grades of cataract were associated with greater postoperative pain.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/prevenção & controle , Medição da Dor , Dipirona/administração & dosagem , Facoemulsificação/métodos , Anestesia e Analgesia/métodos , Cuidados Pós-Operatórios , Administração Tópica , Implante de Lente Intraocular , Manejo da Dor/métodos , Administração Intravenosa , Cuidados Intraoperatórios , Anestésicos Locais/administração & dosagemRESUMO
OBJECTIVE: To compare low doses of pethidine with dipyrone in labor analgesia. METHODS: In a randomized prospective study conducted by Universidade de Fortaleza, in the state of Ceará, Brazil, between May and December 2016, 200 full-term parturients, with very painful uterine contractions and exhibiting uterine cervix dilatation ≥ 5 cm, were selected to receive a single intravenous dose of either 0.25 mg/kg of pethidine (n = 100) or of 25 mg/kg of dipyrone (n = 100). Pain was assessed using the visual analogue scale. The data were analyzed using the Student t-test, the chi-square test and the likelihood ratio. RESULTS: There was a significant improvement in pain in 35% of the parturients. Both drugs presented a similar analgesic effect 1 hour after the intervention (p = 0.692). There was no analgesic effect during the evaluation of the second hour after the intervention with pethidine or dipyrone. There were no adverse effects, such as maternal drowsiness, nausea or vomiting, related to the drugs used. CONCLUSION: Pethidine in low doses and dipyrone presented equivalent analgesia during labor. PUBLIC REGISTRY OF CLINICAL TRIALS: RBR-4hsyy4.
OBJETIVO: Comparar doses baixas de petidina com dipirona na analgesia de parto. MéTODOS: Em um estudo prospectivo randomizado realizado pela Universidade de Fortaleza, Ceará, Brasil, entre maio e dezembro de 2016, 200 parturientes a termo, com contrações uterinas muito dolorosas e apresentando dilatação do colo uterino ≥ 5 cm, foram selecionadas para receber dose única intravenosa de 0,25 mg/kg de petidina (n = 100) ou 25 mg/kg de dipirona (n = 100). A dor foi avaliada pela escala visual analógica. Os dados foram analisados por meio dos testes t de Student, qui-quadrado e razão de verossimilhança. RESULTADOS: Houve melhora significativa da dor em 35% das parturientes. Ambas as drogas apresentaram efeito analgésico semelhante 1 hora após a intervenção (p = 0.692). Inexistiu efeito analgésico durante a avaliação da segunda hora após a intervenção com a petidina ou com a dipirona. Não houve efeitos adversos, como sonolência, náuseas ou vômitos maternos, relacionados aos medicamentos utilizados. CONCLUSãO: A petidina em doses baixas e a dipirona apresentaram analgesia equivalente durante o trabalho de parto. REGISTRO PúBLICO DE TESTES CLíNICOS: RBR-4hsyy4.
Assuntos
Analgesia Obstétrica/métodos , Analgésicos Opioides/administração & dosagem , Dipirona/administração & dosagem , Meperidina/administração & dosagem , Adolescente , Adulto , Índice de Apgar , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Dor do Parto/tratamento farmacológico , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Abstract Objective To compare low doses of pethidine with dipyrone in labor analgesia. Methods In a randomized prospective study conducted by Universidade de Fortaleza, in the state of Ceará, Brazil, between May and December 2016, 200 full-term parturients, with very painful uterine contractions and exhibiting uterine cervix dilatation ≥ 5 cm, were selected to receive a single intravenous dose of either 0.25 mg/kg of pethidine (n = 100) or of 25 mg/kg of dipyrone (n = 100). Pain was assessed using the visual analogue scale. The data were analyzed using the Student t-test, the chi-square test and the likelihood ratio. Results There was a significant improvement in pain in 35% of the parturients. Both drugs presented a similar analgesic effect 1 hour after the intervention (p = 0.692). There was no analgesic effect during the evaluation of the second hour after the intervention with pethidine or dipyrone. There were no adverse effects, such as maternal drowsiness, nausea or vomiting, related to the drugs used. Conclusion Pethidine in low doses and dipyrone presented equivalent analgesia during labor. Public Registry of Clinical TrialsRBR-4hsyy4.
Resumo Objetivo Comparar doses baixas de petidina com dipirona na analgesia de parto. Métodos Em um estudo prospectivo randomizado realizado pela Universidade de Fortaleza, Ceará, Brasil, entre maio e dezembro de 2016, 200 parturientes a termo, com contrações uterinas muito dolorosas e apresentando dilatação do colo uterino ≥ 5 cm, foram selecionadas para receber dose única intravenosa de 0,25 mg/kg de petidina (n = 100) ou 25 mg/kg de dipirona (n = 100). A dor foi avaliada pela escala visual analógica. Os dados foram analisados por meio dos testes t de Student, qui-quadrado e razão de verossimilhança. Resultados Houve melhora significativa da dor em 35% das parturientes. Ambas as drogas apresentaram efeito analgésico semelhante 1 hora após a intervenção (p = 0.692). Inexistiu efeito analgésico durante a avaliação da segunda hora após a intervenção com a petidina ou com a dipirona. Não houve efeitos adversos, como sonolência, náuseas ou vômitos maternos, relacionados aos medicamentos utilizados. Conclusão A petidina em doses baixas e a dipirona apresentaram analgesia equivalente durante o trabalho de parto. Registro público de testes clínicosRBR-4hsyy4.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Dipirona/administração & dosagem , Analgesia Obstétrica/métodos , Analgésicos Opioides/administração & dosagem , Meperidina/administração & dosagem , Índice de Apgar , Infusões Intravenosas , Esquema de Medicação , Estudos Prospectivos , Resultado do Tratamento , Dor do Parto/tratamento farmacológicoRESUMO
Dipyrone (metamizole), acting through its main metabolites 4-methyl-amino-antipyrine and 4-amino-antipyrine, has established analgesic, antipyretic, and spasmolytic pharmacological effects, which are mediated by poorly known mechanisms. In rats, intravenously administered dipyrone delays gastric emptying (GE) of liquids with the participation of capsaicin-sensitive afferent fibers. This effect seems to be mediated by norepinephrine originating from the sympathetic nervous system but not from the superior celiac-mesenteric ganglion complex, which activates ß2-adrenoceptors. In rats, in contrast to nonselective non-hormonal anti-inflammatory drugs, dipyrone protects the gastric mucosa attenuating the development of gastric ulcers induced by a number of agents. Clinically, it has been demonstrated that dipyrone is effective in the control of colic-like abdominal pain originating from the biliary and intestinal tracts. Since studies in humans and animals have demonstrated the presence of ß2-adrenoceptors in biliary tract smooth muscle and ß2-adrenoceptor activation has been shown to occur in dipyrone-induced delayed GE, it is likely that this kind of receptors may participate in the reduction of smooth muscle spasm of the sphincter of Oddi induced by dipyrone. There is no evidence that dipyrone may interfere with small bowel and colon motility, and the clinical results of its therapeutic use in intestinal colic appear to be due to its analgesic effect.
Assuntos
Ampirona/farmacologia , Anti-Inflamatórios não Esteroides/farmacologia , Antipirina/farmacologia , Dipirona/farmacologia , Esvaziamento Gástrico/efeitos dos fármacos , Animais , Bloqueio Nervoso Autônomo , Dipirona/administração & dosagem , Ratos , Ratos WistarRESUMO
OBJECTIVE: To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes. METHODS: This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates. RESULTS: We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (ß = 16; 95%CI 7 - 25; p = 0.002) but substantially decreased in level with the intervention (ß = - 128; 95%CI -195 - -62; p = 0.001) and then progressively decreased (ß = - 24; 95%CI -35 - -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 - -0.05; p = 0.036; 75th percentile difference: -2.23; 95%CI -3.47 - -0.98; p < 0.001). CONCLUSION: A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.
OBJETIVO: Avaliar o impacto de um protocolo de manejo da dor e redução do consumo de opioides no consumo geral de opioides e nos desfechos clínicos. MÉTODOS: Estudo em centro único, quasi-experimental, retrospectivo, de coortes antes e depois. Utilizamos uma série temporal interrompida para analisar as alterações no nível e na tendência de utilização de diferentes analgésicos. Foram usadas comparações bivariadas nas coortes antes e depois, regressão logística e regressão quantílica para estimativas ajustadas. RESULTADOS: Incluímos 988 pacientes no período pré-intervenção e 1.838 no período pós-intervenção. O consumo de fentanil teve ligeiro aumento gradual antes da intervenção (ß = 16; IC95% 7 - 25; p = 0,002), porém diminuiu substancialmente em nível com a intervenção (ß = - 128; IC95% -195 - -62; p = 0,001) e, a partir de então, caiu progressivamente (ß = - 24; IC95% -35 - -13; p < 0,001). Houve tendência crescente de utilização de dipirona. A duração da ventilação mecânica foi significantemente menor (diferença mediana: - 1 dia; IC95% -1 - 0; p < 0,001), especialmente para pacientes mecanicamente ventilados por períodos mais longos (diferença no 50º percentil: -0,78; IC95% -1,51 - -0,05; p = 0,036; diferença no 75º percentil: -2,23; IC95% -3,47 - -0,98; p < 0,001). CONCLUSÃO: Um protocolo de manejo da dor conseguiu reduzir o consumo de fentanil na unidade de terapia intensiva. Esta estratégia se associou com menor duração da ventilação mecânica.
Assuntos
Analgésicos Opioides/administração & dosagem , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Dor/tratamento farmacológico , Adulto , Idoso , Analgésicos/administração & dosagem , Estudos de Coortes , Dipirona/administração & dosagem , Feminino , Fentanila/administração & dosagem , Humanos , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de TempoRESUMO
Dipyrone (metamizole), acting through its main metabolites 4-methyl-amino-antipyrine and 4-amino-antipyrine, has established analgesic, antipyretic, and spasmolytic pharmacological effects, which are mediated by poorly known mechanisms. In rats, intravenously administered dipyrone delays gastric emptying (GE) of liquids with the participation of capsaicin-sensitive afferent fibers. This effect seems to be mediated by norepinephrine originating from the sympathetic nervous system but not from the superior celiac-mesenteric ganglion complex, which activates β2-adrenoceptors. In rats, in contrast to nonselective non-hormonal anti-inflammatory drugs, dipyrone protects the gastric mucosa attenuating the development of gastric ulcers induced by a number of agents. Clinically, it has been demonstrated that dipyrone is effective in the control of colic-like abdominal pain originating from the biliary and intestinal tracts. Since studies in humans and animals have demonstrated the presence of β2-adrenoceptors in biliary tract smooth muscle and β2-adrenoceptor activation has been shown to occur in dipyrone-induced delayed GE, it is likely that this kind of receptors may participate in the reduction of smooth muscle spasm of the sphincter of Oddi induced by dipyrone. There is no evidence that dipyrone may interfere with small bowel and colon motility, and the clinical results of its therapeutic use in intestinal colic appear to be due to its analgesic effect.
Assuntos
Animais , Ratos , Anti-Inflamatórios não Esteroides/farmacologia , Ampirona/farmacologia , Antipirina/farmacologia , Dipirona/farmacologia , Esvaziamento Gástrico/efeitos dos fármacos , Bloqueio Nervoso Autônomo , Dipirona/administração & dosagem , Ratos WistarRESUMO
Objetivo: determinar as diferenças entre volume e número de gotas de dipirona (via oral) por mililitro controlando algumas variáveis. Método: trata-se de um estudo experimental, com abordagem quantitativa, que foi realizado a partir de dados obtidos em experimentos realizados em laboratório, com dois tipos de conta-gotas, temperaturas de 5o e 35o Celsius, além da temperatura ambiente (30o Celsius), de laboratório e os ângulos de 90°, 60° e 45° utilizados para dispensar dipirona. Resultados: com base nos dados coletados, considerou-se que o ângulo de maior confiança para atingir o volume de 20 gotas por cada ml é o ângulo de 90o com o conta-gotas de vidro; em relação à temperatura, a maior confiança no volume de gotas desejado foi alcançada no intervalo de 5o e 30oCelsius. Conclusão: os resultados indicam a necessidade de seguir rigorosamente as orientações do fabricante para que se possa atingir a dose certa na administração de medicamento.
Objective: to determine the differences between volume and number of drops of dipyrone (oral) per milliliter, while controlling some variables. Method: this study applied quantitative analysis to data obtained in laboratory experiments with two types of droppers, temperatures of 5o and 35o Celsius, in addition to ambient temperature (30o Celsius), and the 90°, 60° and 45° angles used to dispense dipyrone. Results: based on the data collected, it was considered that, with the glass dropper, the angle of greatest confidence to achieve the volume of 20 drops per ml is 90o. In relation to temperature, the highest confidence in the desired volume of drops was achieved in the 5o to 30o Celsius interval. Conclusion: the results indicate the need to follow manufacturer's guidelines strictly, so as to achieve the correct dose for drug administration.
Objetivo: determinar las diferencias entre volumen y número de gotas de dipirona (vía oral) por mililitro controlando algunas variables. Método: se trata de un estudio experimental, con enfoque cuantitativo realizado con datos obtenidos en experimentos realizados en laboratorio, con dos tipos de cuentagotas, temperaturas de 5o y 35o Celsius, temperatura ambiente (30° Celsius) de laboratorio y los ángulos de 90°, 60° y 45° para gotear dipirona. Resultados: con base en los datos recolectados, se consideró que el ángulo de mayor confianza para alcanzar el volumen de 20 gotas por cada ml es el ángulo de 90o con el cuentagotas de vidrio. Respecto a la temperatura, la mayor confianza en el volumen de gotas deseado fue alcanzada en el intervalo de 5o y 30o Celsius. Conclusión: los resultados indican la necesidad de seguir rigurosamente las orientaciones del fabricante para alcanzar la dosis correcta en la administración de medicamentos.