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BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of

Tématem bakalářské práce je tlumení porodních bolestí. Práce je rozdělena na část teoretickou a výzkumnou. Teoretická část se v úvodu zabývá porodem a jeho definicí, rozdělením a průběhem. Dále se věnuje bolesti a metodami tlumení porodních bolestí, péčí porodní asistentky a správné komunikaci. Průzkumná část obsahuje rozhovory s prvorodičkami. Hlavním cílem bakalářské práce je zjistit, jaké mají ženy očekávání o porodních bolestech a jak bolesti chtějí tlumit a jaká byla realita., The topic of the bachelor thesis is labour pain management. The thesis is divided into theoretical and research parts. The theoretical part deals with childbirth and its definition, division and course in the introduction. It then discusses pain and methods of labour pain management, midwife care and good communication. The exploratory part includes interviews with first-time mothers. The main aim of the bachelor thesis is to find out what women's expectations about labour pain and how they want to control the pain and what the reality was., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Purpose Patient preferences for labor epidural analgesia (LEA) have been incompletely evaluated. This study aimed to determine the importance of various LEA outcomes to both antenatal and postpartum patients. Methods This was a cross-sectional study approved by the institutional ethics board. Questionnaires were distributed to two separate and distinct cohorts screened for eligibility: pregnant patients at an antenatal visit and postpartum patients during childbirth admission. A list of common LEA outcomes was compiled using research published in leading anesthesia journals. Participants ranked the outcomes according to perceived importance. They assigned each a number from 1 to 10 (priority ranking; 1 indicated the highest priority outcome and 10 the least). They were also asked to 'spend' $100 towards the outcomes (relative value scale), allocating more money to outcomes more important to them. Results Two hundred twenty questionnaires were completed (105 antenatal, 115 postpartum). 'Achieving desired pain relief' was the most important outcome for both cohorts. It was valued more by the postpartum cohort (Median $50 (25 - 60) vs $30 (18 - 50)). 'Overall satisfaction with the pain management,' 'experiencing a short time to achieve pain relief,' and 'experiencing a short duration of labor' received more money than avoiding various LEA-related side effects. The postpartum cohort ranked 'experiencing a short time to achieve pain relief' as more important than the antenatal cohort (Median 5 (3 - 7) vs 3 (2 - 5)). Conclusions Achieving the desired pain relief was the highest LEA outcome preference for both antenatal and postpartum patients. Avoiding side effects was less important relative to pain-related outcomes.

Introduction. Acute pain is a prevalent problem for dementia residents in nursing homes. A variety of intervention strategies have been applied to address this problem. However, there remains an issue of inadequate pain control. This study aims to explore the analgesic efficacy of auricular acupressure (AA) for dementia residents with acute pain in nursing homes. Methods. A multicenter, single-blind, randomized, and sham-controlled clinical trial was performed in three nursing homes in Yinchuan, China. All of the 206 eligible patients with acute pain were randomly divided into two groups for real AA therapy or sham AA (at sham point stimulation) therapy. The primary outcome was measured with a face pain scale revised (FPS-R) score before the procedure, 5 min after the start of the intervention, and 5 min after finishing the procedure. Secondary outcomes covered three physiological parameters, adverse reactions observed, satisfaction level of caregivers, acceptance of patients, and additional use of analgesics. Results. There was a significant difference in pain scores based on FPS-R between the two groups (p<0.01). Pain score in the true AA group was 1.84 ± 0.23, compared with 2.22 ± 0.81 in the sham AA group. No adverse events were found during the whole procedure for all patients. The satisfaction level of caregivers and acceptance of patients in the real AA group were significantly higher than those in the sham AA group. Conclusion. This study shows that real AA was an alternative analgesic modality in reducing acute pain in patients with mild dementia.

Atypical opioids such as tramadol, tapentadol, and cebranopadol combine two complementary mechanisms of action into a single molecule, creating novel analgesic agents. These are synthetic small molecules: cebranopadol is not yet market released; tramadol and tapentadol are commercially available and have immediate-release (IR) and extended-release (ER) formulations. Tramadol has been widely used in the United States in recent years and works as a prodrug in that its metabolites are active in inhibiting serotonin and norepinephrine reuptake. Tapentadol is a direct-acting agent with a faster onset of action and is a muopioid-receptor agonist and also inhibits noradrenaline reuptake. Cebranopadol is the newest of these drugs, a first-in-class atypical analgesic that combines mu-opioid receptor (MOR) agonism with activity at the nociception/orphanin (NOP) FQ petide receptors. Cebranopadol may be considered a partial kappaopioid receptor agonist as well. The pharmacology of these unique single-entity agents allows them to offer analgesic benefit with fewer side effects and risks. Clinical studies have demonstrated the safety and efficacy of tramadol and tapentadol, and promising but limited studies for cebranopadol show good analgesic effect and safety. Serotonin toxicity or 'serotonin syndrome' may occur with accumulation of serotonin with tramadol. While the misuse of these agents is limited in the United States, tramadol misuse is prevalent in Iran and parts of Africa. Patients have been successfully rotated from one of these agents to another. All three agents show promise in the treatment of cancer and non-cancer pain and their unique formulation in a single molecule reduces the pill burden.

type:Text, Systemic sclerosis is a complex disease characterized by extensive fibrosis, microvascular alterations, and additional sequelae. Microvascular alterations can cause painful ulcers and necrosis; however, conservative or surgical treatment is often challenging in terms of healing. The study aimed to describe a toe ulcer with systemic sclerosis and its' successful treatment with spinal cord stimulation. An 83-year-old woman, who was diagnosed with systemic sclerosis over the past decade, was distressed by a non-healing toe ulcer for an extended period of time. The patient underwent spinal cord stimulation treatment with the expectation of pain relief and an improvement in microcirculatory insufficiency. Her pain scales and microcirculation improved, and the toe ulcer healed. Furthermore, the frequency of Raynaud's symptoms was reduced, and the patient's pain decreased. There was no recurrence of the ulcer and she no longer needed a cane for walking.

Introduction Dental pain is primarily treated by dentists and emergency medicine clinicians and may occur because of insult to the tooth or oral surgery. The dental impaction pain model (DIPM) has been widely used in clinical studies of analgesic agents and is generalizable to many other forms of pain. Areas Covered The authors discuss the DIPM, which has allowed for important head-to-head studies of analgesic agents, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and combinations. Postsurgical dental pain follows a predictable trajectory over the course of one to 3 days. Dental pain may have odontic origin or may be referred pain from other areas of the body. Expert opinion Pain following oral surgery has sometimes been treated with longer-than-necessary courses of opioid therapy. Postsurgical dental pain may be moderate to severe but typically resolves in a day or two after the extraction. Opioid monotherapy, rarely used in dentistry but combination therapy (opioid plus acetaminophen or an NSAID), was sometimes used as well as nonopioid analgesic monotherapy. The dental impaction pain model has been valuable in the study of analgesics but does not address all painful conditions, for example, pain with a neuropathic component.

Renal or Nephritic Colic (CN) is one of the main causes of nephrological emergency, with a high incidence in the population, between 10-20% will suffer a CN event in their life, and in diagnosis and treatment there is no medical consensus, therefore, it was necessary to undertake a documentary-descriptive investigation (Baena 2000 and Hernández, Fernández and Baptista 1997), with a documentary process of search, recovery, anal-ysis, criticism and interpretation of data obtained from other researchers (Arias 2006) and a management of the systematization for the treatment of these data (Niño 2011), reaching the following conclusions and rec-ommendations, the diagnosis of CN, especially in emergencies, is essentially clinical, the main objective of emergency treatment of CN is to control or relieve pain, A variety of methods and tools are available to enable you to assess pain (pain scales, systematic pain assessment, among others), to indicate or To evaluate the application of more adequate and effective analgesics, and in the treatment of pain, the use of the analgesic ladder in the various investigations analyzed, allow us to recommend the use of NSAIDs alone or associated., El Cólico Renal o Nefrítico (CN) es una de las principales causas de emergencia nefrológica, con una alta incidencia en la población, entre 10-20% sufrirá un evento de CN es su vida, y en diagnóstico y tratamiento no existe consenso médico, por lo que se hizo necesario emprender una investigación documental-descriptiva (Baena 2000 y Hernández, Fernández y Baptista 1997), con proceso documental de búsqueda, recuperación análisis, crítica e interpretación de datos obtenidos de otros investigadores (Arias 2006) y un manejo de la sistematización para el tratamiento estos datos (Niño 2011), llegando a las siguientes conclusiones y recomendaciones, el diagnóstico del CN, especialmente en urgencias, es esencialmente clínico, el tratamiento en urgencias del CN tiene como principal objetivo el control o alivio del dolor, se dispone de una variedad de métodos y herramientas que le permitirán valorar el dolor (escalas del dolor, la evaluación sistemática del dolor, entre otras), para indicar o revaluar la aplicación de analgésicos más adecuadas y efectivas, y en el tratamiento del dolor, la utilización de la escalera analgésica en las diversas investigaciones analizados, permiten recomendar el uso de AINE solos o asociados.

Background: Intravenous morphine patient-controlled analgesia (PCA) is one of the modalities used by anaesthesiologists to treat patients after operation for acute postoperative pain. About 50% of patients experience inadequate pain control post-surgery when treated with traditional intramuscular (IM) opioids prescribed pro re nata (PRN). Patient-controlled analgesia can also be used to treat patients with chronic pain conditions, advanced metastatic cancer, and in pregnant patients during normal vaginal delivery. The development of intravenous morphine patient-controlled analgesia has led to more effective management of acute postoperative pain, especially in older patients with more comorbid conditions, where a more controlled administration of opioid analgesia is preferred. Other modalities of pain management, like neuraxial and regional analgesia techniques also provide efficacious control of post-surgical pain versus morphine PCA. These techniques are sometimes difficult to perform and contraindicated in patients taking anticoagulation therapy or patients with pre-existing neurological deficits. Intravenous morphine patient-controlled analgesia remains the gold standard for treating pain in these patients. Objectives: The aim and primary objective of the study was to determine how many intravenous (IV) morphine is being used via intravenous morphine patient-controlled analgesia at Universitas Academic Hospital per patient over a 24-hour period and to determine the amount of morphine unused and discarded as wastage. Methods: A retrospective study was conducted including all adult patients that underwent surgery and received intravenous morphine patient-controlled analgesia at Universitas Academic Hospital in Bloemfontein from 2015 to 2017. Data related to morphine PCA usage and presence of side-effects were collected from the PCA record form which is kept in the patient’s file after discharge. Results: A total of 155 patients who received intravenous morphine pa

BackgroundPostoperative opioid use can lead to dependence, contributing to the opioid epidemic in the United States. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increased documentation of persistent opioid use postoperatively, surgeons must pursue interventions to reduce opioid use perioperatively.MethodsWe performed a prospective cohort study to assess the feasibility of a preoperative intervention via patient education or counseling and changes in provider prescribing patterns to reduce postoperative opioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from January 22, 2019 to February 28, 2019 at a tertiary referral, academic endocrine surgery practice. Surveys were administered to assess pain and patient satisfaction postoperatively. Prescription, demographic, and comorbidity data were collected from the electronic health record.ResultsSixty six patients (74.2% women, mean age 58.6 [SD 14.9] y) underwent thyroidectomy (n = 35), parathyroidectomy (n = 24), and other cervical endocrine operations (n = 7). All patients received a preoperative educational intervention in the form of a paper handout. 90.9% of patients were discharged with prescriptions for nonopioid pain medications, and 7.6% were given an opioid prescription on discharge. Among those who received an opioid prescription, the median quantity of opioids prescribed was 135 (IQR 120-150) oral morphine equivalents. On survey, four patients (6.1%) reported any postoperative opioid use, and 94.6% of patients expressed satisfaction with their preoperative education and postoperative pain management.ConclusionsClear and standardized education regarding postoperative pain management is feasible and associated with high patient satisfaction. Initiation of such education may support efforts to minimize unnecessary opioid prescriptions in the population undergoing endocrine surgery.

Dorsal root ganglion (DRG) neurons process pain signaling through specialized nociceptors located in their peripheral endings. It has long been established low voltage-activated (LVA) CaV3.2 calcium channels control neuronal excitability during sensory perception in these neurons. Silencing CaV3.2 activity with antisense RNA or genetic ablation results in anti-nociceptive, anti-hyperalgesic and anti-allodynic effects. CaV3.2 channels are regulated by many proteins (Weiss and Zamponi, 2017), including KLHL1, a neuronal actin-binding protein that stabilizes channel activity by recycling it back to the plasma membrane through the recycling endosome. We explored whether manipulation of KLHL1 levels and thereby function as a CaV3.2 modifier can modulate DRG excitability and mechanical pain transmission or sensitivity to pain. We first assessed the mechanical sensitivity threshold and DRG properties in the KLHL1 KO mouse model. KO DRG neurons exhibited smaller T-type current density compared to WT without significant changes in voltage dependence, as expected in the absence of its modulator. Western blot analysis confirmed CaV3.2 but not CaV3.1, CaV3.3, CaV2.1, or CaV2.2 protein levels were significantly decreased; and reduced neuron excitability and decreased pain sensitivity were also found in the KLHL1 KO model. Analogously, transient down-regulation of KLHL1 levels in WT mice with viral delivery of anti-KLHL1 shRNA also resulted in decreased pain sensitivity. These two experimental approaches confirm KLHL1 as a physiological modulator of excitability and pain sensitivity, providing a novel target to control peripheral pain.

ObjectivesThe aim of this study was to evaluate the impact of epidural analgesia (EA) on postoperative length of stay (LOS), expeditious discharge, and pain relief after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP).MethodsRetrospective reviews of 2014-2015 American College of Surgeons National Surgical Quality Improvement Program databases and our institutional pancreatic surgery database were conducted.ResultsOn univariate analysis, EA was associated with statistically significant longer lengths of stay for both PD and DP. On comparative analysis at mode LOS, discharged before versus after 7 days for PD and 6 days for DP, EA was a significant predictor for the longer groups for both procedures on multivariable analysis (PD, odds ratio of 1.465, P < 0.001; DP, odds ratio of 1.471, P = 0.004). On review of our institution's pancreatic surgery database, patient-reported pain scores were significantly lower in the EA groups than intravenous narcotics groups on the day of surgery only for both PD and DP.ConclusionsEpidural analgesia was associated with longer LOS with a most pronounced effect on early discharge after surgery for patients undergoing open PD and DP. It only resulted in superior pain control on the day of surgery.

Background: Palliative antalgic treatments represent an issue for clinical management and a challenge for scientific research. Radiotherapy (RT) plays a central role. Techniques such as stereotactic body radiotherapy (SBRT) were largely investigated in several phase 2 studies with good symptom response, becoming widely adopted. However, evidence from randomized, direct comparison of RT and SBRT is still lacking. Methods/design: The PREST trial was designed as an interventional study without medicinal treatment. It is a phase 3, open-label, multicentric trial randomized 1:1. Inclusion criteria include painful spinal bone metastases presenting with a pain level > 4 (or > 1 if being treated with an analgesic) on the Numeric Rating Scale (NRS); expected intermediate/high prognosis (greater than 6 months) according to the Mizumoto prognostic score; low spine instability neoplastic score (SINS) sores (< 7); magnetic resonance imaging (MRI) assessment of the bulky lesion. Patients will be assigned to either standard conventional radiotherapy involving 4 Gy × 5 fractions (fx) to the whole involved vertebra or SBRT by intensity modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) involving 7 Gy × 3 fx to the whole involved vertebra + 10 Gy × 3 fx on the macroscopic lesion (gross tumor volume (GTV)). In the experimental arm, the GTV will be contoured by registration with baseline MRI. Discussion: The primary endpoint is overall pain reduction, defined in terms of variation between baseline and 3-month evaluation; pain will be measured using the NRS. Secondary endpoints include pain control duration; retreatment rates (after a minimum interval of 1 month); local control assessed with RECIST criteria; symptom progression free survival; progression-free survival; overall survival; and quality of life (at 0, 30, and 90 days). Accrual of 330 lesions is planned. The experimental arm is expected to have an improvement in overall pain response rates of 15% wi

The aim of our study was to assess the incidence of pain flare and the effectiveness of stereotactic body radiotherapy (SBRT) in pain management of patients with bone oligometastases. We evaluated 48 patients accounting for 54 treatments. The Edmonton Classification System for Cancer Pain (ECS-CP) was applied to identify indicators of treatment-resistant pain, in patients with active pain (NRS ≥ 2) at baseline. Statistical analysis was performed to identify predictors of pain flare and pain control. Pain flare occurred in 38% of treated patients (n = 18/48): No correlation was found between pain flare and patient- or treatment-related variables. In the subset of patients with active pain at baseline (n = 23), pain control was obtained in 62% of patients at 1 year; median time to pain progression after SBRT was 29 months (CI95% 6–52 months). Presence of ≥2ECS-CP features was correlated with earlier pain progression (4 vs. 30 months, p = 0.012). Pain flare occurred in 38% of cases irrespectively of steroid premedication and dose regimen. In patient with baseline active pain, durable pain control was obtained. Presence of ≥2 complexity indicators at the ECS-CP assessment was correlated with impaired pain control and may deserve future investigation in prospective studies.

ObjectiveTo review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.DesignTopical review.MethodsRandomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.ResultsA total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from high-quality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.ConclusionsWhile there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

This paper is a summary of presentations on postoperative pain control by the authors at the 2014 PainForum meeting in People's Republic of China. Postoperative pain is often untreated or undertreated and may lead to subsequent chronic pain syndromes. As more procedures migrate to the outpatient setting, postoperative pain control will become increasingly more challenging. Evidence-based guidelines for postoperative pain control recommend pain assessment using validated tools on a consistent basis. In this regard, consistency may be more important than the specific tool selected. Many hospitals have introduced a multidisciplinary acute pain service (APS), which has been associated with improved patient satisfaction and fewer adverse events. Patient education is an important component of postoperative pain control, which may be most effective when clinicians chose a multimodal approach, such as paracetamol (acetaminophen) and opioids. Opioids are a mainstay of postoperative pain control but require careful monitoring and management of side effects, such as nausea, vomiting, dizziness, and somnolence. Opioids may be administered using patient-controlled analgesia systems. Protocols for postoperative pain control can be very helpful to establish benchmarks for pain management and assure that clinicians adhere to evidence-based standards. The future of postoperative pain control around the world will likely involve more and better established APSs and greater communication between patients and clinicians about postoperative pain. The changes necessary to implement and move forward with APSs is not a single step but rather one of continuous improvement and ongoing change.

Analgesic pain management for acute pain resulting from ocular sulfur mustard (SM) exposure in rabbits involves delivery of the opioid receptor agonist buprenorphine using subcutaneously implanted osmotic pumps. The combination of an invasive surgery, risk of postsurgical infection and central effects makes this system suboptimal. Alternatively, fentanyl, a synthetic opioid with predominantly mu receptor agonist activity, is significantly more potent than buprenorphine, with fewer associated CNS side effects. Fentanyl is commercially available as a transdermal patch (Duragesic ), obviating the need for surgery and the risks of secondary complications. To evaluate fentanyl transdermal patches (FPs) as a novel analgesic delivery system for the acute pain associated with ocular SM exposures in rabbits, we studied the analgesic efficacy, conducted resource cost-comparisons and assessed the ease of use and compatibility of FPs with experimental protocols. We found that FP use resulted in decreased symptoms of rabbit pain and distress, reduced experimental duration by 39%, reduced personnel requirements by 14%, and lowered total experimental costs by 43%, or over $8,400 per each 16-rabbit exposure. These data suggest that FPs provide efficient, cost-effective and humane analgesia following ocular SM exposure, while eradicating the discomfort, distress and risk associated with implantation and removal of osmotic pumps., The original document contains color images.

Preemptive analgesia is a type of antinoceptive therapy which aims preventing both central and peripheral sensitizations, decreasing (or preferentially preventing) post-operative amplification of pain. This study had as main objective to carry out a literature review associated with the theme, seeking to identify the effectiveness of the technique and additionally to propose a pharmacological protocol with rational use of medicinal products available on the Brazilian market. The review of literature is clear regarding the safety and efficacy of the technique, however, there is no consensus on the arrangements to be standardized. It seems to be hopeful the association of analgesics with peripheral action with oral corticosteroids., A analgesia preemptiva é uma terapia antinoceptiva que objetiva prevenir ambas as sensibilizações centrais e periféricas, diminuindo (ou preferencialmente prevenindo) a amplificação da dor pós-operatória. Este trabalho teve por finalidade principal realizar uma revisão de literatura associada ao tema, buscando identificar a eficácia da técnica de analgesia preemptiva no controle da dor pós-operatória, com a intenção de propor um protocolo farmacológico de atendimento com uso racional de medicamentos disponíveis no mercado nacional. A revisão da literatura é clara no que tange a segurança e eficácia da técnica, entretanto, não há consenso sobre qual o regime a ser padronizado. A associação de analgésicos de ação periférica com corticosteróides por via oral tem sido proposta como uma alternativa eficaz para analgesia pré-emptiva.

Preemptive analgesia is a type of antinoceptive therapy which aims preventing both central and peripheral sensitizations, decreasing (or preferentially preventing) post-operative amplification of pain. This study had as main objective to carry out a literature review associated with the theme, seeking to identify the effectiveness of the technique and additionally to propose a pharmacological protocol with rational use of medicinal products available on the Brazilian market. The review of literature is clear regarding the safety and efficacy of the technique, however, there is no consensus on the arrangements to be standardized. It seems to be hopeful the association of analgesics with peripheral action with oral corticosteroids., A analgesia preemptiva é uma terapia antinoceptiva que objetiva prevenir ambas as sensibilizações centrais e periféricas, diminuindo (ou preferencialmente prevenindo) a amplificação da dor pós-operatória. Este trabalho teve por finalidade principal realizar uma revisão de literatura associada ao tema, buscando identificar a eficácia da técnica de analgesia preemptiva no controle da dor pós-operatória, com a intenção de propor um protocolo farmacológico de atendimento com uso racional de medicamentos disponíveis no mercado nacional. A revisão da literatura é clara no que tange a segurança e eficácia da técnica, entretanto, não há consenso sobre qual o regime a ser padronizado. A associação de analgésicos de ação periférica com corticosteróides por via oral tem sido proposta como uma alternativa eficaz para analgesia pré-emptiva.

The Institute of Surgical Research (USAISR) is the U.S. Army s lead research laboratory for improving the care of combat casualties. The Institute follows a rigorous process for analyzing patterns of injury and the burden of disease to determine where research can be conducted in order to positively impact care. This analysis led the USAISR to focus research on: preventing death from bleeding; developing improved pain control techniques; developing improved vital signs analysis techniques; improving the treatment of extremity injuries; preventing burn injuries on the battlefield; and improving critical care for combat casualties. This process has resulted in numerous improvements in care on the battlefield. Highlights include development, fielding, and efficiency testing of tourniquets and improved dressings for bleeding control. Significant progress has also been made in the resuscitation of combat casualties using blood products instead of crystalloid or colloid solutions. Improvements in pain control include assessments of the effect of perioperative anesthetics on the development of Post-Traumatic Stress Disorder (PTSD). Novel vital signs analyses have been successful in identifying promising techniques which may improve the medic s ability to accurately triage patients. Current research in extremity injuries has focused on optimizing the use of negative pressure wound therapy for contaminated wounds. Burn research has focused on improving personnel protective equipment and developing continuous renal replacement therapy. This research program is soldier focused and addresses care from self aid and buddy aid through all echelons of care. Many of these advances have been adopted in civilian medical centers as well, benefiting not only the military trauma patient, but also the civilian trauma patient. The future of the USAISR includes expansion of the mission and resources to include dental, eye, and blood product research in collaboration with the U.S. Navy and U, See also ADA564622. Use of Advanced Technologies and New Procedures in Medical Field Operations (Utilisation de technologies avancees et de procedures nouvelles dans les operations sanitaires). RTO-MP-HFM-182

This study evaluated the effects of 25 mg of intramuscular (IM) ketamine versus 10 mg of IM morphine versus saline placebo on the performance of representative Warrior Skill Tasks in 48 healthy subjects. Ketamine demonstrated rapid onset of action and hemodynamic stability but did not result in improved Soldier performance. Overall, subjects reported more symptoms associated with ketamine versus morphine and placebo, chiefly among them dizziness, poor concentration, and feelings of happiness. Performance decrements on ketamine, when present, manifested as slower performance times rather than procedural errors. This may represent the adoption of a cautious posture suggested by risk propensity testing whereby the subject is aware of his or her impairment, trading speed for preservation of task accuracy. Despite the fact that subjects were more symptomatic on ketamine, the Warrior Skill Tasks were largely resistant to performance decrements, suggesting that a trained task skill (autonomous phase) remains somewhat resilient to the drugged state at this dosage., The original document contains color images.

BACKGROUND AND OBJECTIVES:Ambulatory perineural local anesthetic infusion is a relatively new method for providing postoperative analgesia, and many aspects of this technique remain in the domain of conjecture and speculation. This retrospective chart review and survey was undertaken to investigate patients' opinions on various aspects of their ambulatory perineural infusion experience. METHODS:Patients who had received an ambulatory perineural infusion from the University of Florida were identified via pharmacy records. Patients were contacted by phone and were asked various questions regarding their experiences and preferences during and after their perineural infusion. RESULTS:Of 217 patients identified, 215 charts were located and retrieved. Of these, 137 (64%) were successfully contacted and 131 (61%) consented to take part in the survey. More than 97% of patients reported that they felt "safe" during home infusion, that one physician telephone call each night was optimal contact, and that they were comfortable removing the catheter with instructions given over the phone. Only 4% would have preferred to return for catheter removal, and 43% felt that they would have been comfortable with only written instructions for catheter removal. CONCLUSION:This investigation suggests that perineural local anesthetic infusion is generally well tolerated by ambulatory patients.

Despite international agreements and recommendations regarding cancer pain therapy, the effectiveness of pain treatment is still a major problem even in Western countries. Part of the problem is that physicians and nurses often lack knowledge of methods for the assessment and treatment of cancer pain and may have many rigid beliefs and attitudes. This study investigated the misconceptions of physicians and nurses that play a role in the undertreatment of pain in Flanders (Belgium). We approached 197 health care workers who participated in the pain and symptom control education sessions organized by the Federation Palliative Care Flanders, and asked them to complete a questionnaire both before and after the sessions. The impact of the education sessions on their knowledge and beliefs regarding the management of cancer pain was substantial. Methods of reaching the target groups that do not feel the need for further education are discussed., SCOPUS: ar.j, info:eu-repo/semantics/published

This project developed patient educational materials for lower-income African American and Hispanic women with breast cancer and cancer-related pain. The development of the materials was guided by the results of studies designed to establish the educational needs of women of each ethnic heritage. A manuscript describing the results of our baseline studies has been published in Cancer, and three book chapters have been written using project data. The results of the baseline studies indicated that over half of the minority women were experiencing severe pain and that their physicians underestimated pain severity. The second study found that the women's health care providers demonstrated conservative pain management practices. They reported inadequate pain assessment and patient reluctance to report pain as top barriers to optimal pain treatment. The patient educational materials are designed to teach women how to communicate with their providers about their pain. The materials also discuss effective pain management and dispel myths about opioid medications. The educational materials are being tested in a randomized clinical trial at sites that serve minority patients. Patient recruitment and accrual have been slow but are gradually increasing. An additional one year unfunded extension has been requested to finish the clinical trial.

Approximately 60% of outpatients with metastatic breast cancer have pain and one-third have pain that restrict their ability to function. Compared with middle class patients those from underserved populations are three times as likely to be undermedicated with analgesics: Over 60% of African-American and over 80% of Hispanic patients get inadequate analgesic prescriptions. They have typical concerns that limit their reporting of pain and their use of analgesics. We are assessing the needs of minority breast cancer outpatients for information and skills needed to manage pain. In Phase II we will develop multi-media education and training materials that are linguistically and culturally appropriate for Hispanic and African-American populations. To accomplish these tasks we have (a) formed a network of three urban public hospitals that treat these patients and (b) established a multi-disciplinary team to meet project goals. We will evaluate the effectiveness of this training program in a randomized, controlled clinical trial for minority outpatients with metastatic breast cancer and disease-related pain. If this program is effective, it can easily be introduced by other care centers where these patients are treated.