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Copyright of Wissen Kompakt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intrathecal therapy (IT) is an effective treatment indicated in the management of chronic refractory pain, although it is not without possible complications. We describe a case of infection after the 4th replacement of an intrathecal morphine (IM) pump, which led to the device removal and the consequent difficulty for the systemic management of high doses of opioids. A 77-year-old man, multi-pathological, with failed back syndrome and carrying a high-dose MI pump for 25 years. Generator replacement was complicated by surgical wound infection, initially treated conservatively with antibiotics and surgical debridement. A preventive decrease in the dose of MI was started. After failure of conservative treatment, removal of the device was required, initiating intravenous opioid replacement regimen initially, and later orally. During the postoperative period, the patient experiences acute confusional syndrome with agitation, altered level of consciousness, and hypercapnic respiratory failure. This condition requires multidisciplinary treatment with adjustment of the opioid dose, administration of antipsychotic drugs, sedatives and adaptation of non-invasive mechanical ventilation. Complications such as infection of the IT device can lead to an abrupt withdrawal of the drug with the consequent withdrawal syndrome (WS). Need to substitute systemically for high doses of IT opioids is highly complex. The patient developed an acute confusional syndrome, hard to manage and initially attributed to WS. Other differential diagnoses of the situation were opioid intoxication, hypoxia, hypercapnia, infection, adverse effects of antibiotics... Adjustment of the opioid dose and treatment with antipsychotics (aripiprazole) allowed to control the symptoms. [ABSTRACT FROM AUTHOR]

Although the chronic consumption of alcohol and sedatives, and increasingly opioids, represents a major problem in old age with consequential damage for those affected, little attention has been paid to the substance abuse disorders in old age. The aim of the present recommendations, a collaboration work of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP), Swiss Nurses Association (SBK) and Swiss Society of Addiction Medicine (SSAM), is to summarize the current state of knowledge in prevention, diagnostics and therapy of substance abuse disorders in old age for an interprofessional clinical team. They are intended to help strengthen prevention and early diagnosis, and consciously emphasize psychotherapy and nursing intervention options. [ABSTRACT FROM AUTHOR]

Consumption of pain medication, especially opioids, has risen sharply since 2000, both worldwide and in Switzerland. However, it is unknown whether this increased use is associated with an increase in new approvals of pain medications. An analysis of new approvals of painkillers in Switzerland showed a significant increase from the year 2000 onwards. The majority of new registrations were strong opioid preparations, while the trend in new registrations of non-opioid painkillers was decreasing. Furthermore, the treatment duration of newly approved strong opioids increased significantly from the year 2000 onwards, which may lead to a higher risk of overdoses or dependence. [ABSTRACT FROM AUTHOR]

Introduction: Cancer related- pain causes a negative psychosocial and physical impact on patients’ lives. The purpose of this review was to investigate the current strategies for cancer pain treatment. Material and Methods: We conducted a PubMed search of the literature published from 2018 to 2020, and details were extracted from the articles with adequate study quality. Discussion: Of 63 titles, 19 studies were selected and used in review. Conclusions: This review article focuses on the novel treatments available for cancer pain management. [ABSTRACT FROM AUTHOR]

Several pathways and neurochemical systems involved in the pathophysiology of migraine are currently being investigated with the aim of designing new drugs. In this review, we analyse the current status of the most promising therapeutic targets in the medium term of these investigations, which are the ones being studied in phase 2 trials. In this way we examine the new opioids that interact on the KOR and DOR receptors, the cannabinoids, the glutamate and nitric oxide pathways, the orexin and the tryptophan-kirunenic pathways, the PACAPergic system, and the ionic channels. The latter, specifically those of potassium, have acquired special relevance recently so we will focus our attention on them. [ABSTRACT FROM AUTHOR]

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Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Wiener Klinisches Magazin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Manuelle Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We compared the analgesia and cardiopulmonary changes induced by epidural methadone or fentanyl in combination with lidocaine in female dogs undergoing elective ovariohysterectomy and anesthetized with propofol. Eighteen female dogs were randomly assigned to two groups and given either methadone (0.3 mg kg?¹) + 2% lidocaine without vasoconstrictor (LM) or fentanyl (5 µg kg?¹) + 2% lidocaine without vasoconstrictor (LF). The drugs were administered epidurally in a volume of 0.25 ml kg?¹. Heart rate (HR), respiratory rate (RR), rectal temperature (RT), systolic blood pressure (SBP), and blood glucose levels were recorded before and 15 minutes after premedication (T0 and T1); 15 minutes after epidural administration (T2); five minutes after dermotomy (T3); five minutes after clamping of the ovarian pedicle (T4); five minutes and 1, 3, 6, 12, 18, and 24 hours (T5, T6, T7, T8, T9, T10, and T11, respectively) after surgery. The number of additional propofol injections and total propofol dose (mg kg?¹) were recorded. Analgesia was assessed using a numerical descriptive scale. SBP and HR were similar in both groups, but hypotension was detected in animals from both groups at different times. Respiratory rate decreased significantly at T6 in the LF group and was lower than in the LM group. Hypothermia was observed in animals from both groups, but RT was significantly lower than baseline values only at T4 in the LM group. Blood glucose levels increased significantly only in the LF group at T4, T7, and T8. All animals in the LF group and eight animals in the LM group required additional propofol injections at T4, but no significant differences were detected in the number of propofol injections and total propofol dose between the LF (3 ± 1 injections, 7.5 ± 4.5 mg kg?¹) and LM (2 ± 2 injections, 4.5 ± 3.4 mg kg?¹) groups. The latency period, anesthetic period, and the duration of surgery were similar in both groups. No animals required rescue analgesia. The lidocaine-methadone and lidocaine-fentanyl combinations caused minimal cardiorespiratory changes, but did not abolish pain at the time of handling of the ovarian pedicle.

Opioid maintenance treatment with methadone or buprenorphine is an established first-line treatment for opioid dependence. In addition to the novel weekly and monthly subcutaneously injectable buprenorphine depot CAM 2038 (Buvidal®), which is already available in Germany, two other long-acting buprenorphine formulations may be introduced in the near future: the monthly depot formulation RBP-6000 (Sublocade™) and a 6-month buprenorphine depot implant (Probuphine™). Basic pharmacological and clinical data of these three medications are given and possible clinical applications are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Forensische Psychiatrie, Psychologie, Kriminologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Brasileira de Anestesiologia is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A Comissão para o Manejo da Dor estabeleceu um plano de melhoria no controle da dor em 2012. Avaliar as tendências do consumo de analgésicos em um hospital de ensino terciário e o impacto econômico associado. Estudo descritivo, retrospectivo, feito entre 2011 e 2015. A análise incluiu: produtos anti‐inflamatórios e antirreumáticos não esteroides, analgésicos opioides e outros analgésicos e antipiréticos. Os dados foram convertidos em DDD/100 leitos‐dia para analisar as tendências de consumo. Principal medida do desfecho: avaliação do consumo de analgésicos após o estabelecimento de um plano de melhoria no controle da dor. O consumo total de produtos anti‐inflamatórios e antirreumáticos não esteroides diminuiu em 24,8 DDD/100 leitos‐dia (−28,3%), representando a maior parte da redução total do consumo de analgésicos (−13%) e o custo total (−44,3%). O consumo global de opioides aumentou acentuadamente de 22,3 DDD/100 leitos‐dia em 2011 para 26,5 DDD/100 leitos‐dia em 2015 (+18,9%). Em 2011, o opioide mais consumido foi a morfina (8,6 DDD/100 leitos‐dia). No entanto, houve uma tendência crescente no consumo de fentanil (de 8,1 para 12,1 DDD/100 leitos‐dia em 2015), o que resultou na substituição de morfina por fentanil como o opioide mais consumido em 2015 (12,1 DDD/100 leitos‐dia). Em 2015, o grupo dos outros analgésicos e antipiréticos representou 46,2% do consumo total de analgésicos. Acetaminofeno foi o analgésico mais consumido (53,2 DDD/100 leitos‐dia em 2015) e teve o maior custo total, representou 55,4% do custo total em 2015. O consumo de opioides mostrou uma tendência crescente durante o período de cinco anos, fentanil substituiu morfina como o opioide mais usado. Em geral, o uso diminuído de analgésicos foi devido à tendência decrescente do consumo de produtos anti‐inflamatórios e antirreumáticos não esteroides. Pain management committee established a pain performance improvement plan in 2012. The aim of the study was to assess the trends in analgesic consumption in a tertiary teaching hospital and the associated economic impact. A descriptive, retrospective study was conducted between 2011 and 2015. The analysis included: anti‐inflammatory and antirheumatic products non‐steroids, opioid analgesics and other analgesics and antipyretics. Data are converted into DDD/100 bed‐days to analyze consumption trends. Main outcome measure: assessment of the analgesic consumption after the implementation of a pain performance improvement plan. Overall, non‐steroidal anti‐inflammatory and antirheumatic products consumption decreased in 24.8 DDD/100 bed‐days (–28.3%), accounting for most of the total analgesic consumption decrease (–13%) and total cost (–44.3%). Opioid consumption increased markedly from 22.3 DDD/100 bed‐days in 2011 to 26.5 DDD/100 bed‐days in 2015 (+18.9%). In 2011, the most consumed opioid was morphine (8.6 DDD/100 bed‐days). However, there was an increasing trend in fentanyl consumption (from 8.1 to 12.1 DDD/100 bed‐days in 2015), which resulted in fentanyl replacing morphine from the most consumed opioid in 2015 (12.1 DDD/100 bed‐days). In 2015, the group of other analgesics and antipyretics represented 46.2% of the total analgesic consumption. Acetaminophen was the most commonly consumed analgesic drug (53.2 DDD/100 bed‐days in 2015) and had the highest total cost, it represented 55.4% of the overall cost in 2015. Opioid consumption showed an increasing trend during the 5 year period, with fentanyl replacing morphine as the most used opioid. In general, analgesics diminished use was due to the decreasing trend of consumption of non‐steroidal anti‐inflammatory and antirheumatic products. [ABSTRACT FROM AUTHOR]

This article presents and compares different forms of therapy for chronic pain. Chronic pain is a major problem for public health, associated with important consequences for patients and their families, an elevated use of medical assistance and immense social costs. Chronic pain is presented as a multidisciplinary problem, reflecting the complex character of pain mechanisms. Because of this complexity there are many barriers against the efficacy of pain treatment. This article mentions the advantages and disadvantages of long- and short-time use of opioids. Then, the article studies new substances that have proven significant antalgic effects in clinical and preclinical trials. The possibility of the use of such substances, as well as the advantages and disadvantages are further discussed in the article. Even though this therapy methods require further trials to enter the pain management guides, their efficacy, the possibility of individualized therapy and the absence of addiction open new gates for an efficient analgesic therapy with a better compliance from patients and a rise in the quality of their lives. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Herz-, Thorax- und Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The discovery of the local anaesthetic effect by blocking sodium ion channels was a milestone in anaesthesia but was soon limited by sometimes life-threatening toxic effects of the local anaesthetics. By developing novel local anaesthetics and also by adding so-called adjuvants, attempts have been made to limit these life-threatening events. This article focuses on the historic background and the current state of the use of these adjuvants for regional anaesthesia. Adding epinephrine, clonidine or dexmedetomidine, but only as a single dose, results in a faster onset, longer duration of action and increased intensity of neuronal blockade of regional anaesthesia. The benefits of adding sodium bicarbonate, on the other hand, are relatively minor and, therefore, clinically negligible. Although increasing evidence in the literature suggests an improvement and prolongation of the analgesic effect after axonal administration of opioids, which can also be given continuously, systemic effects are not fully ruled out due to the increased incidence of central side effects. The partial local anaesthetic effects of opioids cannot always be distinguished from opioid receptor-specific effects. Mechanistic studies postulate a functional coupling of opioid receptors in injured rather than in intact peripheral nerves. Recent studies have identified glucocorticoid and mineralocorticoid receptors predominantly on peripheral nociceptive nerve fibers. This is consistent with numerous clinical reports of a marked prolongation of the local anaesthetic effect. In addition to the known genomic effects of steroids that occur via a change in gene expression of pain-sustaining protein structures, faster non-genomic effects are also discussed, which occur via a change in intracellular signaling pathways. In summary, new insights into mechanisms and novel results from clinical trials will help the anaesthesiologist in the decision to use adjuvants for regional anaesthesia which, however, requires to weigh the individual patient's benefits against the risks. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.

Die freigiebige Verschreibung und einfache Verfügbarkeit opioidhaltiger Arzneimittel bewirkten in den USA vielfach einen missbräuchlichen Konsum und Opioidabhängigkeiten. Dies wiederum führte zu strikteren Verordnungen, wodurch illegale Rauschgifte an Bedeutung gewannen – einhergehend mit einer Erhöhung der Anzahl der Drogentoten. In Deutschland zeichnet sich bisher keine ähnliche Entwicklung ab, allerdings ist ein enges Monitoring der Entwicklung notwendig, um frühzeitig reagieren zu können. Munificent prescription behavior combined with easy availability of opioid-containing drugs contributed to the development of widespread opioid abuse and addiction in the USA. Increased regulation of prescriptions led to increasing substitution with illegal narcotics yielding in a significant increase of drug-related deaths. In Germany, no similar development has been observed to date, but close monitoring of developments is necessary to be able to take countermeasures at an early stage. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of tramadol on tear production, intraocular pressure (IOP) and pupil diameter (PD) in healthy dogs. Dogs were randomly assigned to receive 4mg kg-1 (n=11) and 6mg kg-1 (n=11) of tramadol hydrochloride intramuscularly. Tear production (Schirmer tear test, STT-1), IOP (applanation tonometry) and the PD (electronic pachymetry) were assessed before, 30 and 60 minutes after administration of tramadol. Data were compared by analysis of variance for repeated measures (P

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Rheumatologie. Supplements is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to investigate the effects of the systemic administration of acepromazine, tramadol and the association of both on intraocular pressure (IOP) and pupil diameter (PD) in young healthy cats. Cats were randomly allocated into three groups (n=10/each) and intramuscular acepromazine (AG), tramadol (TG) or acepromazine combined with tramadol (ATG) were injected. PD (electronic caliper) and IOP (applanation tonometry) were assessed before (baseline) and following 15, 30, 60, and 120 minutes of treatments. It was verified that in AG, PD decreased significantly from time point 30 to 120 (P=0.002), but such reduction did not differ significantly from baseline (P=0.89). In TG, PD increased significantly from the first 15 minutes, until the last time point of evaluation (P<0.001). In ATG, PD increased significantly from time point 30 to 120 when compared to baseline (P<0.001); but significant differences from time point 30 to 120 were not seen (P=0.71). Comparisons among groups showed that PD values of TG and ATG were significantly higher than that of AG (P<0.05). IOP values, on the other hand, did not change significantly among time points and groups (P>0.05). It can be concluded that tramadol alone or in association with acepromazine produced significant mydriasis for up to 120 minutes, without changing IOP values in normal cats. Results of this study suggested that tramadol alone or in association with acepromazine caused significant mydriasis and did not change IOP values in normal cats. Therefore, it may be considered a satisfactory pre-anesthetic combination for ophthalmic surgery in cats. However, further studies are warranted on the use of such protocols in cats with ophthalmic diseases undergoing ocular or intraocular surgery. [ABSTRACT FROM AUTHOR]

Background: Although ruminants experience pain like other species, diagnosis and treatment may be imprecise and challenging, especially because of lack of recognition and restraint of therapeutic resources. In addition to the restrictions inherent in the species, organic dysfunctions may further restrict the analgesic arsenal, making it necessary to find viable and effective alternative for pain control. The continuous administration of opioids in the epidural space has been highlighted as an analgesic resource in several species. However, until this moment, there are few information on this practice in ruminants. Therefore, the aim of this study was to describe the use of continuous epidural infusion of morphine in a sheep undergoing to urethrostomy with a history of chronic pain and urolithiasis. Case: A 3-year-old Santa Ines sheep, weighting 110 kg, was presented to the Veterinary Hospital of Federal University of Bahia with history of recurrent urolithiasis, lameness, severe pain and continuous use of nonsteroidal anti-inflammatory drug (NSAID). The findings of the physical examination, imaging and laboratory tests revealed possible abomasum inflammation, chronic laminitis, left humerus-radioulnar osteoarthritis and urethral urolithiasis with uremia. A clinical stabilization of the animal was performed, including an interruption of the use of the NSAID and the administration of fluid, urinary acidifier (ammonium chloride), histamine H2 receptor antagonist (ranitidine), cytoprotectant (sucralfate), antibiotic (norfloxacin) and dipyrone. After 3 days, urethrostomy was performed followed by the implantation of an epidural catheter (19G) in the lumbosacral space (L7 - S1) by means of a Tuohy needle (18G), after the surgical procedure. Administration of morphine (0.1 mg kg-1) through the catheter at 24-h intervals, associated with dipyrone (25 mg kg-1) intravenously (IV), every 8 h, over a 5-day period, was the postoperative analgesic protocol chosen. The data of heart rate (HR), respiratory rate (f), rectal temperature (T °C), ruminal movements (RM) and possible behavior related to pain were registered at intervals of four-hours until the fifth day after surgery. After 24 h postoperative, stability of the variables (HR, f, T °C) with increased RM concomitant to the interest for food was verified. On the fifth postoperative day, the animal was hydrated, visibly comfortable and with normal levels of serum creatinine. Discussion: Considering the initial clinical status involving renal insufficiency and significant gastric abnormalities, the use of NSAIDs was immediately disregarded. However, the need to relieved musculoskeletal and postoperative pain, has raised interest in the use of morphine, whose literature refers duration of up to 24 h in other species, with reduced adverse effects compared to systemic administration, due to the considerably lower dose. Dipyrone was incorporated into the protocol for providing visceral analgesia and minimal effects on the organic functions. During the 5-days of evaluation, the signs of well-being presented by the animal associated to the stability of vital parameters, feeding and satisfactory ruminal activity attested to the viability of the protocol tested. It was concluded that the use of morphine, through the continuous epidural route, contributed to the relief of postoperative pain, reestablishment of the organic functions and patient welfare, being suitable as an analgesic alternative to NSAID use in sheep. [ABSTRACT FROM AUTHOR]

JUSTIFICATIVA E OBJETIVOS: A dor do tipo breakthrough ocorre com frequência em pacientes oncológicos e é pouco estudada no Brasil. Este estudo teve como objetivo estudar as características da dor do tipo breakthrough e comparar a evolução durante três dias.METODOS: Trata-se de um estudo longitudinal em que foi aplicado um questionário específico criado para a pesquisa e composto por dados sociodemográficos (idade, gênero, estado civil, profissão, renda, procedência), dados referentes ao câncer (tipos de tumor primário, existência de metástase, abordagem terapêutica como quimioterapia e/ou radioterapia, tratamento cirúrgico e fármacos) e parâmetros referentes à dor do tipo breakthrough(número de episódios por dia, duração da crise, intensidade, velocidade de inicio da dor e as variedades de dor do tipo breakthrough: espontânea, incidental e falha do fármaco no final da dose).RESULTADOS: A maioria era do gênero feminino (71,7%), com idade de 30 a 50 anos (41,7%), realizava quimioterapia e radioterapia concomitante (41,7%), e tinha câncer de colo uterino (54,2%). A média da intensidade dolorosa foi 7, com desvio padrão de 2,3. Em relação à presença de dor do tipo breakthrough, não houve diferença estatisticamente significativa nos três momentos de avaliação. Durante as três avaliações observou-se que houve redução no percentual de pacientes que sentiam dor com tempo acima de 15 minutos na terceira avaliação (p=0,004). Não houve diferença entre as três avaliações quanto ao perfil farmacológico (p=0,34).CONCLUSÃO: A dor do tipo breakthrough foi frequente na população estudada. O uso de opioides mostrou eficácia na diminuição do tempo de dor e dor espontânea.

This study assessed the clinical effects and the mechanical antinociceptive potential of intravenous (IV) tramadol in horses.A blinded and randomized study was designed with 7 horses treated with 1 (Tr1), 2 (Tr2) or 3 (Tr3) mg kg-1 of tramadol IV. The heart rate, respiratory rate (fR), arterial pressure, degree of sedation, gastrointestinal motility (GI), behavior changes and the mechanical nociceptive threshold (MNT) were evaluated. The MNT was determined with von Frey device method.Tr3 had a significant increase in their fR and more pronounced behavioral changes than other treatments.The Tr1 showed a significant increase in arterial pressure. The GI reduced significantly, mainly in Tr2. The tramadol did not change the MNT of the horses.The clinical alterations observed with the different treatments were considered mild and transitory, being most evident in Tr2. However the tramadol did not have any analgesic effect with any of the doses evaluated.