jueves, 16 de febrero de 2017

Dolor en niños / Pain in children

Febrero 16, 2017. No. 2602

Intervenciones psicológicas basadas en la evidencia para el manejo del dolor crónico pediátrico: nuevas direcciones en la investigación y la práctica clínica.

Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice.

Coakley R1,2, Wihak T3.

Children (Basel). 2017 Feb 4;4(2). pii: E9. doi: 10.3390/children4020009.

Abstract

Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family's particular needs is increasingly possible. This article will (1) discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2) review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3) discuss future directions for intervention research on pediatric chronic pain.

KEYWORDS: child; chronic pain; empirically supported; evidence-based; parent; pediatric; psychological intervention

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Validación de la escala de Satisfacción de Adolescentes con Manejo Postoperatorio del Dolor - Escoliosis idiopática (SAP-S).

Validation of the scale on Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S).

Khadra C1, Le May S2, Ballard A2, Théroux J3, Charette S4, Villeneuve E5, Parent S6, Tsimicalis A7, MacLaren Chorney J8.

J Pain Res. 2017 Jan 11;10:137-143. doi: 10.2147/JPR.S124365. eCollection 2017.

Abstract

BACKGROUND: Spinal fusion is a common orthopedic surgery in children and adolescents and is associated with high pain levels postoperatively. If the pain is not well managed, negative outcomes may ensue. To our knowledge, there is no measure in English that assesses patient's satisfaction with postoperative pain management following idiopathic scoliosis surgery. The aim of the present study was to assess the psychometric properties of the satisfaction subscale of the English version of the Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S) scale. METHODS: Eighty-two participants aged 10-18 years, who had undergone spinal fusion surgery, fully completed the SAP-S scale at 10-14 days postdischarge. Construct validity was assessed through a principal component analysis using varimax rotation. RESULTS: Principal component analysis indicated a three-factor structure of the 13-item satisfaction subscale of the SAP-S scale. Factors referred to satisfaction regarding current medication received (Factor 1), actions taken by nurses and doctors to manage pain (Factor 2) and information received after surgery (Factor 3). Cronbach's alpha was 0.91, showing very good internal consistency. Data on satisfaction and clinical outcomes were also reported. CONCLUSION: The SAP-S is a valid and reliable measure of satisfaction with postoperative pain management that can be used in both research and clinical settings to improve pain management practices. Although it was developed and validated with adolescents who had undergone spinal fusion surgery, it can be used, with further validation, to assess adolescents' satisfaction with pain management in other postoperative contexts.

KEYWORDS: adolescents; orthopedics; pain management; postoperative pain; satisfaction; scoliosis

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Práctica actual y avances recientes en el manejo del dolor pediátrico

Current practice and recent advances in pediatric pain management

A. CHIARETTI, F. PIERRI *, P. VALENTINI, I. RUSSO*, L. GARGIULLO, R. RICCARDI*

European Review for Medical and Pharmacological Sciences 2013; 17(Suppl 1): 112-126

Abstract

BACKGROUND: Differently from the adult patients, in pediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, selection of appropriate pain assessment tools should consider age, cognitive level and the presence of eventual disability, type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drugs pharmacokinetics should facilitate a better management of childhood pain. AIM: The objective of this review is to discuss current practice and recent advances in pediatric pain management. METHODS: Using PubMed we conducted an extensive literature review on pediatric pain assessment and commonly used analgesic agents from January 2000 to January 2012. CONCLUSIONS: A multimodal analgesic regimen provides better pain control and functional outcome in children. Cooperation and communication between the anaesthesiologist, surgeon, and paediatrician are essential for successful anaesthesia and pain management. Key Words: Pain, Pain assessment, Analg

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5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.

Committee for European Education in Anaesthesiology (CEEA)

y el Colegio de Anestesiólogos de León A.C.

Abril 7-9, 2017, León Guanajuato, México

Informes (477) 716 06 16, kikinhedz@gmail.com

Regional Anesthesiology and Acute Pain Medicine Meeting

April 6-8, 2017, San Francisco, California, USA

ASRA American Society of Regional Anesthesia and Pain Medicine

Información / Information

Anestesiología y Medicina del Dolor

52 664 6848905

vwhizar@anestesia-dolor.org

anestesia-dolor.org

Instabilidad traumática del codo – Dislocación fractura del cúbito proximal

http://www.mihombroycodo.com.mx/academia/instabilidad-traumatica-del-codo-dislocaciones-proximales-de-la-fractura-del-cubito/

Traumatic Elbow Instability – Proximal Ulna Fracture Dislocations

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/fhdHCtmaJEQ

Courtesy:
Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University
Philadelphia
Pennsylvania
USA
www.orthoclips.com

Publicado el 21 ene. 2017

Narrated, annotated lecture 3 of 3 on traumatic elbow instability (proximal ulna fracture dislocations) from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.

Categoría
- Comedia
Licencia
- Licencia de YouTube estándar

Efectos de la fatiga en la cadera en corredores con síndrome de la bandeleta iliotibial (ITBS)

http://www.lesionesdeportivas.com.mx/academia/efectos-de-la-fatiga-en-la-cadera-en-corredores-con-sindrome-de-la-bandeleta-iliotibial-itbs/

The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27718393

http://www.clinbiomech.com/article/S0268-0033(16)30150-4/abstract

http://www.anatomia-fisioterapia.es/28-systems/musculoskeletal/lower-extremity/knee/2143-efectos-de-la-fatiga-en-la-cadera-en-corredores-con-itbs

De:

Brown AM¹, Zifchock RA², Hillstrom HJ³, Song J⁴, Tucker CA⁵.

Clin Biomech (Bristol, Avon). 2016 Nov;39:84-90. doi: 10.1016/j.clinbiomech.2016.09.012. Epub 2016 Sep 30.

Efectos de la fatiga en la cadera en corredores con ITBS

El síndrome de la bandeleta iliotibial (ITBS) es la segunda lesión más frecuente en corredores. El dolor está localizado habitualmente en la cara lateral de la rodilla. Las alteraciones de la cinemática que se han mencionado en relación al ITBS son: incremento de la aducción de la cadera y rotación interna de la rodilla durante la carrera. Estudios previos han mencionado también la posibilidad de la falta de coordinación en la cadera y la rodilla, que puede conducir a cambios cinemáticos en la extremidad inferior. El propósito del siguiente estudio fue determinar los efectos de la fatiga en la cinemática de la cadera, y los patrones de acoplamiento articular en corredores con ITBS comparado con sujetos sanos.

Los corredores con ITBS mostraron un incremento de los ángulos de aducción durante la fase de apoyo. Se ha sugerido que los corredores con ITBS alteran su marcha de tal modo que el pico del ángulo de aducción de cadera disminuye. Se midió una diferencia de 18’5% entre el grupo con ITBS y los controles sanos. No se encontró diferencia en la abducción o la rotación interna de cadera.

Otro factor que se ha sugerido como contribuyente al ITBS es la debilidad abductora de cadera: la fatiga de los rotadores externos y abductores puede alterar la cinemática de la carrera. Sin embargo, no parece que la debilidad de la musculatura abductora sea la causa del ITBS, ya que la fatiga de esta musculatura no estaría solo presente en forma de aumento de la aducción de cadera, sino también en un incremento de la rotación interna durante la fase de apoyo. Esto no se observó en este estudio.

Como limitación de este estudio observamos que se hizo correr a los sujetos a una velocidad fija y durante una distancia muy corta, lo cual podría automáticamente haber alterado su mecánica de carrera.

AbstractBACKGROUND:

Altered hip and knee kinematics and joint coupling have been documented in runners with iliotibial band syndrome. Symptoms often present themselves after several minutes of running, yet the effect of fatigue warrants further exploration. The purpose of this study was to determine the effect of a run to fatigue in runners with iliotibial band syndrome, as compared to healthy controls.

METHODS:

Twenty uninjured and 12 female runners with iliotibial band syndrome performed a treadmill run to fatigue. Prior-to and following a run to fatigue, overground running data were collected. Variables of interest included stance phase: peak hip adduction and internal rotation, peak hip abductor and external rotator joint moments and frontal-sagittal plane hip and knee joint coupling.

FINDINGS:

Fatigue resulted in decreased peak hip adduction angles in injured runners. Fatigue did not affect injured runners differently than controls with respect to the remaining variables. Coupling differences did not exist between healthy and injured runners with respect to the loading or propulsive phases of stance.

INTERPRETATION:

While clinicians often strengthen hip abductor muscles and provide gait re-training to decrease stance phase hip adduction, our results suggest that, when exerted, female runners with iliotibial band syndrome independently modify their running gait to decrease hip adduction, potentially as a result of pain. Fatigue did not have an effect on the remaining study variables. It is possible that reducing the length of the iliotibial band through minimizing hip adduction reduces pain, but the other variables examined are not sensitive to this phenomenon.

KEYWORDS:

Fatigue; Hip; Running injury; Vector coding

PMID: 27718393 DOI:

10.1016/j.clinbiomech.2016.09.012

[PubMed – in process]

#corredores #cadera #lesiones deportiva

Dislocación protésica y revisión después de la artroplastia total primaria de cadera en pacientes con fusión lumbar

http://www.cirugiavertebral.com.mx/academia/dislocacion-protesica-y-revision-despues-de-la-artroplastia-total-primaria-de-cadera-en-pacientes-con-fusion-lumbar/

Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/27998660

http://www.arthroplastyjournal.org/article/S0883-5403(16)30829-4/abstract

De:

Perfetti DC1,Schwarzkopf R2,Buckland AJ2,Paulino CB3,Vigdorchik JM2.

J Arthroplasty. 2016 Nov 23. pii: S0883-5403(16)30829-4. doi: 10.1016/j.arth.2016.11.029. [Epub ahead of print]

Abstract

ACKGROUND:

Lumbar-pelvic fusion reduces the variation in pelvic tilt in functional situations by reducing lumbar spine flexibility, which is thought to be important in maintaining stability of a total hip arthroplasty (THA). We compared dislocation and revision rates for patients with lumbar fusion and subsequent THA to a matched comparison cohort with hip and spine degenerative changes undergoing only THA.

METHODS:

We identified patients in New York State who underwent primary elective lumbar fusion for degenerative disc disease pathology and subsequent THA between January 2005 and December 2012. A propensity score match was performed to compare 934 patients with prior lumbar fusion to 934 patients with only THA according to age, gender, race, Deyo comorbidity score, year of surgery, and surgeon volume. Revision and dislocation rates were assessed at 3, 6, and 12 months post-THA.

RESULTS:

At 12 months, patients with prior lumbar fusion had significantly increased rates of THA dislocation (control: 0.4%; fusion: 3.0%; P < .001) and revision (control: 0.9%; fusion: 3.9%; P < .001). At 12 months, fusion patients were 7.19 times more likely to dislocate their THA (P < .001) and 4.64 times more likely to undergo revision (P < .001).

CONCLUSION:

Patients undergoing lumbar fusion and subsequent THA have significantly higher risks of dislocation and revision of their hip arthroplasty than a matched cohort of patients with similar hip and spine pathology but only undergoing THA. During preoperative consultation for patients with prior lumbar fusion, orthopedic surgeons must educate the patient and family about the increased risk of dislocation and revision.

Resumen
ANTECEDENTES:
La fusión lumbar-pélvica reduce la variación de la inclinación pélvica en las situaciones funcionales al reducir la flexibilidad de la columna lumbar, lo que se cree que es importante para mantener la estabilidad de una artroplastia total de cadera (THA). Se compararon las tasas de dislocación y revisión para los pacientes con fusión lumbar y THA subsiguiente a una cohorte de comparación igualada con cambios degenerativos de cadera y columna sometidos sólo a THA.

MÉTODOS:
Se identificaron pacientes en el estado de Nueva York que se sometieron a la fusión lumbar electiva primaria para la enfermedad degenerativa de disco y la THA subsecuente entre enero de 2005 y diciembre de 2012. Se realizó un puntaje de propensión para comparar 934 pacientes con fusión lumbar previa a 934 pacientes con sólo THA según Edad, sexo, raza, puntuación de comorbilidad de Deyo, año de cirugía y volumen del cirujano. Las tasas de revisión y dislocación se evaluaron a los 3, 6 y 12 meses después de THA.

RESULTADOS:
A los 12 meses, los pacientes con fusión lumbar anterior habían aumentado significativamente las tasas de dislocación THA (control: 0,4%, fusión: 3,0%, P <0,001) y revisión (control: 0,9%, fusión: 3,9% . A los 12 meses, los pacientes con fusión fueron 7,19 veces más propensos a dislocarse su THA (P <0,001) y 4,64 veces más probabilidades de someterse a revisión (P <0,001).

CONCLUSIÓN:
Los pacientes sometidos a fusión lumbar y THA posteriores tienen riesgos significativamente más altos de dislocación y revisión de su artroplastia de cadera que una cohorte emparejada de pacientes con patología similar de cadera y columna, pero sólo sometidos a THA. Durante la consulta preoperatoria para pacientes con fusión lumbar previa, los cirujanos ortopédicos deben educar al paciente ya su familia sobre el aumento del riesgo de dislocación y revisión.

KEYWORDS:

degenerative spine disease; dislocation; instability; lumbar fusion; revision; total hip arthroplasty

PMID: 27998660 DOI:

10.1016/j.arth.2016.11.029

[PubMed – as supplied by publisher]

#fusión lumbar #enfermedad degenerativa #columna #dislocación #inestabilidad #artroplastia total de cadera #Dislocación protésica