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[PMID]:29466161
[Au] Autor:Kim A; Sendlewski G; Zador E; Kalsi M; Zador L; Kurup V
[Ad] Endereço:From the Department of Anesthesiology, Yale University School of Medicine, New Haven, CT. Address reprint requests to Dr. Kim at Brigham and Women's Hospital, Department of Anesthesiology and Perioperative and Pain Medicine, 75 Francis St., Boston, MA 02115, or at akim30@bwh.harvard.edu .
[Ti] Título:Placing a Lumbar Epidural Catheter.
[So] Source:N Engl J Med;378(8):e11, 2018 Feb 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Cateterismo/métodos
Vértebras Lombares
[Mh] Termos MeSH secundário: Analgesia Epidural/instrumentação
Anestesia Local/instrumentação
Anestesia Local/métodos
Cateterismo/efeitos adversos
Cateterismo/instrumentação
Contraindicações de Procedimentos
Seres Humanos
Vértebras Lombares/anatomia & histologia
Vértebras Lombares/diagnóstico por imagem
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMvcm1500438


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[PMID]:29384888
[Au] Autor:Seo YG; Kim SH; Choi SS; Lee MK; Lee CH; Kim JE
[Ad] Endereço:Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do.
[Ti] Título:Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia: A retrospective study.
[So] Source:Medicine (Baltimore);97(5):e9837, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment.Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50% reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support.Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P = .001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95% confidence interval [CI]: 1.75-15.23) in the acute group and 5.37 (95% CI: 1.62-17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95% CI: 1.20-7.73) in the acute group and 4.46 (95% CI: 1.20-16.54) in the chronic group.CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.
[Mh] Termos MeSH primário: Amidas/uso terapêutico
Analgesia Epidural
Anestésicos/uso terapêutico
Fentanila/uso terapêutico
Herpes Zoster/tratamento farmacológico
Neuralgia Pós-Herpética/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Feminino
Herpes Zoster/complicações
Herpes Zoster/diagnóstico
Seres Humanos
Masculino
Meia-Idade
Neuralgia Pós-Herpética/diagnóstico
Neuralgia Pós-Herpética/virologia
Medição da Dor
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Amides); 0 (Anesthetics); 7IO5LYA57N (ropivacaine); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009837


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[PMID]:28746153
[Au] Autor:Aloia TA; Kim BJ; Segraves-Chun YS; Cata JP; Truty MJ; Shi Q; Holmes A; Soliz JM; Popat KU; Rahlfs TF; Lee JE; Wang XS; Morris JS; Gottumukkala VNR; Vauthey JN
[Ad] Endereço:*Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX †Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX ‡Department of Surgery, Mayo Clinic, Rochester, MN §Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX ¶Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
[Ti] Título:A Randomized Controlled Trial of Postoperative Thoracic Epidural Analgesia Versus Intravenous Patient-controlled Analgesia After Major Hepatopancreatobiliary Surgery.
[So] Source:Ann Surg;266(3):545-554, 2017 09.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The primary objective of this randomized trial was to compare thoracic epidural analgesia (TEA) to intravenous patient-controlled analgesia (IV-PCA) for pain control over the first 48 hours after hepatopancreatobiliary (HPB) surgery. Secondary endpoints were patient-reported outcomes, total narcotic utilization, and complications. BACKGROUND: Although adequate postoperative pain control is critical to patient and surgeon success, the optimal analgesia regimen in HPB surgery remains controversial. METHODS: Using a 2.5:1 randomization strategy, 140 patients were randomized to TEA (N = 106) or intravenous patient-controlled analgesia (N = 34). Patient-reported pain was measured on a Likert scale (0-10) at standard time intervals. Cumulative pain area under the curve was determined using the trapezoidal method. RESULTS: Between the study groups key demographic, comorbidity, clinical, and operative variables were equivalently distributed. The median area under the curve of the postoperative time 0- to 48-hour pain scores was lower in the TEA group (78.6 vs 105.2 pain-hours, P = 0.032) with a 35% reduction in patients experiencing ≥7/10 pain (43% vs 62%, P = 0.07). Patient-reported outcomes and total opiate use further supported the benefit of TEA on patient experience. Anesthesia-related events requiring change in analgesic therapy were comparable (12.2% vs 2.9%, respectively, P = 0.187). Grade 3 or higher surgical complications (6.6% vs 9.4%), median length of stay (6 days vs 6 days), readmission (1.9% vs 3.1%), and return to the operating room (0.9% vs 3.1%) were similar (all P > 0.05). There were no mortalities in either group. CONCLUSIONS: In major HPB surgery, TEA provides a superior patient experience through improved pain control and less narcotic use, without increased length of stay or complications.
[Mh] Termos MeSH primário: Analgesia Epidural
Analgesia Controlada pelo Paciente
Analgésicos/administração & dosagem
Hepatectomia
Dor Pós-Operatória/tratamento farmacológico
Pancreaticoduodenectomia
Cuidados Pós-Operatórios/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Analgesia Epidural/métodos
Analgesia Controlada pelo Paciente/métodos
Analgésicos/uso terapêutico
Feminino
Seguimentos
Seres Humanos
Infusões Intravenosas
Masculino
Meia-Idade
Medidas de Resultados Relatados pelo Paciente
Estudos Prospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Analgesics)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002386


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[PMID]:29045499
[Au] Autor:Sitras V; Saltyte Benth J; Eberhard-Gran M
[Ad] Endereço:Department of Obstetrics and Gynaecology, Akershus University Hospital, Oslo, Norway.
[Ti] Título:Obstetric and psychological characteristics of women choosing epidural analgesia during labour: A cohort study.
[So] Source:PLoS One;12(10):e0186564, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To investigate the obstetric and psychological characteristics of women who opt to use epidural analgesia (EDA) during labour and the impact of participating in labour preparation courses on women's decisions to use EDA. DESIGN: Longitudinal cohort study. SETTING: Akershus University Hospital, Norway. POPULATION: 2596 women with singleton pregnancies and intended vaginal delivery. METHODS: Data were collected using two self-completed questionnaires at pregnancy weeks 17 and 32. Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ). Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and depression by the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and socio-demographic information was retrieved from birth records at the maternity ward. MAIN OUTCOME MEASURE: Preference for EDA was indicated by the questionnaire item "I would prefer an epidural regardless" on a 4-point scale (1 = highly agree, 4 = highly disagree) at pregnancy week 32. RESULTS: Twenty-one percent of the women (540/2596) answered that they would choose EDA as the only alternative method of analgesia during labour. Counselling for fear of childbirth [OR 3.23 (95%CI 2.12; 4.92)] and W-DEQ sum score ≥ 85 [OR 2.95 (95%CI 2.06; 4.23)] were significantly (p<0.001) associated with choice of EDA. Participation in labour preparation courses was significantly (p = 0.008) associated with a reduction of intended use of EDA during labour [OR 0.67 (95%CI 0.49; 0.90)]. CONCLUSION: Fear of childbirth is significantly associated with women's choice of EDA during labour. On the other hand, women that participate in labour preparation courses would rather consider other methods of analgesia during labour.
[Mh] Termos MeSH primário: Analgesia Epidural/psicologia
Parto Obstétrico/psicologia
Trabalho de Parto/psicologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Intervalos de Confiança
Feminino
Seres Humanos
Saúde Mental
Razão de Chances
Paridade
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186564


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[PMID]:29045482
[Au] Autor:van Samkar G; Hermanns H; Lirk P; Hollmann MW; Stevens MF
[Ad] Endereço:Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands.
[Ti] Título:Influence on number of top-ups after implementing patient controlled epidural analgesia: A cohort study.
[So] Source:PLoS One;12(10):e0186225, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Postoperative epidural analgesia often needs rate readjustment using top-ups. Patient-controlled epidural analgesia (PCEA) is said to reduce the requirement of epidural top-ups when compared to continuous epidural analgesia (CEA). We compared CEA and PCEA in major thoracic and abdominal surgery, in a cohort study. The primary endpoint was the required number of epidural top-ups. Secondary endpoints were pain scores, side effects and workload differences. We analysed 199 patients with CEA and 187 with PCEA. Both groups had similar pain scores. The total number of top-ups was 75 in 57 patients (CEA) versus 20 top-ups in 18 patients (PCEA). (p = 0.0001) Sedation tended to occur more frequently in patients with CEA versus PCEA, 5.5% vs 1.6% (p = 0.05). Implementation of PCEA led to a decreased number of top-ups, fewer side-effects and decreased use of the postoperative care unit.
[Mh] Termos MeSH primário: Analgesia Epidural
Analgésicos Opioides/administração & dosagem
Anestésicos Locais/administração & dosagem
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Analgesia Controlada pelo Paciente
Bupivacaína/administração & dosagem
Feminino
Fentanila/administração & dosagem
Seres Humanos
Masculino
Medição da Dor/métodos
Dor Pós-Operatória/fisiopatologia
Cuidados Pós-Operatórios
Período Pós-Operatório
Procedimentos Cirúrgicos Torácicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); UF599785JZ (Fentanyl); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186225


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[PMID]:29016499
[Au] Autor:Shen X; Li Y; Xu S; Wang N; Fan S; Qin X; Zhou C; Hess PE
[Ad] Endereço:Departments of Anesthesiology and Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; and the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.
[So] Source:Obstet Gynecol;130(5):1097-1103, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.08% ropivacaine with 0.4 micrograms/mL sufentanil with patient-controlled epidural analgesia. At the onset of the second stage of labor, women were randomized to receive a blinded infusion of the same solution or placebo saline infusion. The primary outcome was the duration of the second stage of labor. A sample size of 200 per group (400 total) was planned to identify at least a 15% difference in duration. RESULTS: Between March 2015 and September 2015, 560 patients were screened and 400 patients (200 in each group) completed the study. Using an intention-to-treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52). The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17). Pain scores were similar between groups at each measurement during the second stage. More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001). CONCLUSION: Maintaining the infusion of epidural medication had no effect on the duration of the second stage of labor compared with a placebo infusion. Maternal and neonatal outcomes were similar. A low concentration of epidural local anesthetic does not affect the duration of the second stage of labor. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Register, http://www.chictr.org.cn/enindex.aspx, ChiCTR-IOR-15005875.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Analgesia Obstétrica/métodos
Analgésicos/administração & dosagem
Dor do Parto/tratamento farmacológico
Segunda Fase do Trabalho de Parto/efeitos dos fármacos
[Mh] Termos MeSH secundário: Amidas/administração & dosagem
Método Duplo-Cego
Feminino
Seres Humanos
Gravidez
Sufentanil/administração & dosagem
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Amides); 0 (Analgesics); 7IO5LYA57N (ropivacaine); AFE2YW0IIZ (Sufentanil)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002306


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[PMID]:28984753
[Au] Autor:Zhang JH; Wang ZL; Wan L
[Ad] Endereço:a903 Hospital, Jiangyou City, Sichuan Province bThe Second Affiliated Hospital, State Key Clinical Specialty in Pain Medicine, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China.
[Ti] Título:Cervical epidural analgesia complicated by epidural abscess: A case report and literature review.
[So] Source:Medicine (Baltimore);96(40):e7789, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required. PATIENT CONCERNS: Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication. DIAGNOSES: This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan. INTERVENTIONS: The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks. OUTCOMES: After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period. LESSONS: Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.
[Mh] Termos MeSH primário: Analgesia Epidural/efeitos adversos
Vértebras Cervicais
Abscesso Epidural/etiologia
Deslocamento do Disco Intervertebral/tratamento farmacológico
Cervicalgia/tratamento farmacológico
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Hipertensão/complicações
Deslocamento do Disco Intervertebral/complicações
Cervicalgia/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007789


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[PMID]:28926440
[Au] Autor:Lee AI; McCarthy RJ; Toledo P; Jones MJ; White N; Wong CA
[Ad] Endereço:From the Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, Texas (A.I.L.); Department of Anesthesiology (R.J.M., P.T., M.J.J.) and Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois (R.J.M., P.T.); Department of Nursing, Northwestern Memorial Hospital Chicago, Illinois (N.W.); and Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.).
[Ti] Título:Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.
[So] Source:Anesthesiology;127(4):614-624, 2017 Oct.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. METHODS: The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 µg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 µg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. RESULTS: A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 µg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 µg [95% CI of the difference, -58 to 79 µg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. CONCLUSIONS: Labor epidural solutions containing fentanyl concentrations as high as 2 µg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Analgesia Obstétrica/métodos
Analgésicos Opioides
Aleitamento Materno/estatística & dados numéricos
Fentanila
Trabalho de Parto
[Mh] Termos MeSH secundário: Adulto
Relação Dose-Resposta a Droga
Método Duplo-Cego
Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics, Opioid); UF599785JZ (Fentanyl)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001793


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[PMID]:28782603
[Au] Autor:Hanna MH; Jafari MD; Jafari F; Phelan MJ; Rinehart J; Sun C; Carmichael JC; Mills SD; Stamos MJ; Pigazzi A
[Ad] Endereço:Department of Surgery, School of Medicine, University of California, Irvine, CA.
[Ti] Título:Randomized Clinical Trial of Epidural Compared with Conventional Analgesia after Minimally Invasive Colorectal Surgery.
[So] Source:J Am Coll Surg;225(5):622-630, 2017 Nov.
[Is] ISSN:1879-1190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The effectiveness of thoracic epidural analgesia (EA) vs conventional IV analgesia (IA) after minimally invasive surgery is still unproven. We designed a randomized controlled trial comparing EA with IA after minimally invasive colorectal surgery. STUDY DESIGN: A total of 87 patients who underwent minimally invasive colorectal procedures at a single institution between 2011 and 2014 were enrolled. Eight patients were excluded and 38 were randomized to EA and 41 to IA. Pain was assessed with the Visual Analogue Scale and quality of life with the Overall Benefit of Analgesia Score daily until discharge. RESULTS: Mean age was 57 ± 14 years, 43% of patients were female, and mean BMI was 28.6 ± 6 kg/m . The 2 groups were similar in demographic characteristics and distribution of diagnoses and procedures. Epidural analgesia had a higher incidence of hypotensive systolic blood pressure (<90 mmHg) episodes (9 vs 2; p < 0.05) and a trend toward longer Foley catheter duration (3 ± 2 days vs 2 ± 4 days; p > 0.05). Epidural and IA had equivalent mean lengths of stay (4 ± 3 days vs 4 ± 3 days), daily Visual Analogue Scale scores (2.4 ± 2.0 vs 3.0 ± 2.0), and Overall Benefit of Analgesia Scores (3.2 ± 2.0 vs 3.2 ± 2.0), and similar time to start oral diet (2.8 ± 2 days vs 2.2 ± 1 days). Epidural analgesia patients used a higher total dose of narcotics (147.5 ± 192.0 mg vs 98.1 ± 112.0 mg; p > 0.05). Epidural and IV analgesia had equivalent total hospital charges ($144,991 ± $67,636 vs $141,339 ± $75,579; p > 0.05). CONCLUSIONS: This study indicates that EA has no added clinical benefit in patients undergoing minimally invasive colorectal surgery. A trend toward higher total narcotics use and complications with EA was demonstrated.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Analgesia Controlada pelo Paciente/métodos
Procedimentos Cirúrgicos do Sistema Digestório
Procedimentos Cirúrgicos Minimamente Invasivos
Manejo da Dor/métodos
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Medição da Dor
Dor Pós-Operatória/diagnóstico
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE


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[PMID]:28749944
[Au] Autor:de Jonge A; Peters L; Geerts CC; van Roosmalen JJM; Twisk JWR; Brocklehurst P; Hollowell J
[Ad] Endereço:Department of Midwifery Science, AVAG and Amsterdam Public Health research institute, VU University Medical Center at Amsterdam, Amsterdam, the Netherlands.
[Ti] Título:Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands.
[So] Source:PLoS One;12(7):e0180846, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands. METHODS: Data were combined from the Birthplace study in England (from April 2008 to April 2010) and the National Perinatal Register in the Netherlands (2009). Low risk women in England planning birth at home (16,470) or in freestanding midwifery units (11,133) were compared with Dutch women with planned home births (40,468). Low risk English women with births planned in alongside midwifery units (16,418) or obstetric units (19,096) were compared with Dutch women with planned midwife-led hospital births (37,887). RESULTS: CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj) OR 1.89 (95% CI 1.64 to 2.18) and 3.66 (2.90 to 4.63) respectively). Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups. CONCLUSIONS: When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.
[Mh] Termos MeSH primário: Centros de Assistência à Gravidez e ao Parto
Parto Obstétrico/estatística & dados numéricos
Parto Domiciliar
Complicações na Gravidez/epidemiologia
[Mh] Termos MeSH secundário: Analgesia Epidural
Anestesia
Cesárea
Inglaterra/epidemiologia
Episiotomia
Feminino
Seres Humanos
Trabalho de Parto/fisiologia
Países Baixos/epidemiologia
Ocitocina/farmacologia
Planejamento de Assistência ao Paciente
Períneo/patologia
Gravidez
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
50-56-6 (Oxytocin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180846



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