Formulaciones de buprenorfina / Buprenorphine Formulations

Enero 30, 2018. No. 2979

Formulaciones de buprenorfina: recomendaciones de estrategias clínicas de mejores prácticas para el manejo perioperatorio de pacientes sometidos a procedimientos de dolor quirúrgico o intervencional. Buprenorphine Formulations: Clinical Best Practice Strategies Recommendations for Perioperative Management of Patients Undergoing Surgical or Interventional Pain Procedures. Jonan AB1, Kaye AD, Urman RD2. Author information Pain Physician. 2018 Jan;21(1):E1-E12. Abstract BACKGROUND: Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesiachallenging. OBJECTIVES: To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period. The present investigation aims to review the literature and provide recommendations when encountering a patient on buprenorphine therapy who is scheduled for a surgical or interventional pain procedure. METHODS: Clinical studies and reviews were searched using the PubMed National Center for Biotechnology Information database using MeSH terms buprenorphine, buprenorphine and naloxone, suboxone, perioperative, and postoperative pain. RESULTS: PubMed National Center for Biotechnology Information database search resulted in one randomized control trial, one prospective case matched cohort, one retrospective cohort, 0 case series, 4 case reports, and 6 review articles. Key literature is reviewed and summarized. LIMITATIONS: Only 12 articles were included, which permits only limited recommendations drawn from this review. CONCLUSIONS: The perioperative management of buprenorphine and buprenorphine/naloxone are dependent on several key factors. The nature of the surgery, namely the postoperative opioid requirement, elective versus emergency surgery, patient characteristics, formulation of buprenorphine, and indication for buprenorphine or buprenorphine/naloxone therapy must be considered when devising a plan. Several options exist when formulating a plan for the perioperative management, including continuing buprenorphine therapy or holding buprenorphine therapy for a defined period of time with or without bridging to alternative opioids. Additionally, social support people and patient motivation should be addressed and optimized, as well as nonopioid adjuvant therapy should be maximized as applicable to each patient undergoing a surgical or interventional pain procedure. KEY WORDS: Buprenorphine, naloxone, surgery, pain management, anesthesia, suboxone, opioid abuse. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Ketamina en dolor por anemia falciforme / Ketamine and sickle cell disease pain

Enero 28, 2018. No. 2977 La evaluación del uso de ketamina para el control del dolor con la crisis de células falciformes en el embarazo: un informe de 2 casos. Evaluating the Use of Ketamine for Pain Control With Sickle Cell Crisis in Pregnancy: A Report of 2 Cases. Gimovsky AC, Fritton K, Viscusi E, Roman A. A A Pract. 2018 Jan 1;10(1):20-22. doi: 10.1213/XAA.0000000000000624. Abstract Sickle cell crises occur frequently during pregnancy and are difficult to treat, even with high-dose opioids. Analgesia with ketamine has been suggested as an alternative, but its use during pregnancy is underreported. Two pregnant patients with uncontrolled sickle cell pain were treated with ketamine. Patient A reported no decrease in her pain, but her opioid requirements decreased. Patient B's pain resolved during ketamine administration. No serious maternal or neonatal adverse effects occurred. Ketamine may be considered as an adjunct analgesic in pregnant patients with sickle cell pain, although prospective clinical data are needed to fully assess its efficacy. PDF El papel de un régimen de dosis bajas de ketamina-midazolam en el tratamiento de la crisis dolorosa severa en pacientes con enfermedad de células falciformes. The role of a low-dose ketamine-midazolam regimen in the management of severe painful crisisin patients with sickle cell disease. Tawfic QA1, Faris AS2, Kausalya R3. Author information J Pain Symptom Manage. 2014 Feb;47(2):334-40. doi: 10.1016/j.jpainsymman.2013.03.012. Epub 2013 Jul 12 Abstract CONTEXT: Acute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration. OBJECTIVES: We studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis. METHODS: A retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics. A ketamine-midazolam regimen was added to the ongoing opioids as an initial bolus of ketamine 0.25mg/kg, followed by infusion of 0.2-0.25mg/kg/h. A midazolam bolus of 1mg followed by infusion of 0.5-1mg/h was added to reduce ketamine emergence reactions. Reduction in morphine daily requirements and improvement in pain scores were the determinants of ketamine-midazolam effect. The t-tests were used for statistical analysis. RESULTS: Nine patients were assessed, with mean age of 27±11 years. Morphine requirement was significantly lower after adding the IV ketamine-midazolam regimen. The mean±SD IV morphine requirement (milligram/day) in the pre-ketamine day (D0) was 145.6±16.5, and it was 112±12.2 on Day 1 (D1) of ketamine treatment (P=0.007). The Numeric Rating Scale scores on D0 ranged from eight to ten (mean 9.1), but improved to range from five to seven (mean 5.7) on D1. There was a significant improvement in pain scores after adding ketamine-midazolam regimen (P=0.01). CONCLUSION: Low-dose ketamine-midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sicklecell disease with severe painful crisis. Further controlled studies are required to prove this effect. Sickle cell disease; ketamine; midazolam; pain management; painful crisis PDF Crisis drepanocítica y tratamiento del dolor A. Rojas-Martínez, E. Calderón, M.A. Vidal, F. Arroyo, R. García-Hernández y L.M. Torres Rev Soc Esp Dolor 2015; 22(4): 165-167 RESUMEN La drepanocitosis incluye un grupo de desórdenes genéticamente heredados en los que a baja saturación de oxígeno ocurre la agregación de polímeros rígidos de hemoglobina S desoxigenada, otorgando forma de hoz al hematíe y dañando el endotelio vascular por medio de múltiples mecanismos, obstruyendo concomitantemente la microcirculación y produciendo una estimulación de nociceptores. Los pacientes con drepanocitosis pueden presentar múltiples tipos de dolor dependiendo de las estructuras lesionadas, siendo el de tipo músculo-esquelético el más frecuente. La base del manejo del dolor es el reconocimiento y la evaluación de la severidad, ya que de esta dependerá la prescripción del tratamiento analgésico. Las crisis vasooclusivas son la manifestación más característica de esta enfermedad. Una vez instaurado el dolor, el manejo inicial debe enfocarse en proveer control rápido del mismo, garantizándose dosis terapéuticas de los fármacos, y en la detección de complicaciones. Debe evitarse el uso no indicado de las terapias y el tratamiento infraterapéutico, acompañado de un seguimiento cuidadoso, prevención y tratamiento de los efectos adversos. El tratamiento del dolor crónico se hace de forma multidisciplinaria, considerando estrategias no farmacológicas. Palabras clave: Drepanocitosis. Células falciformes. Crisis veno-oclusivas. Opioides. Dolor intenso. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

CALIDAD DE VIDA EN PACIENTES CON ARTROPATÍA DE MANGUITO ROTADOR

http://www.mihombroycodo.com.mx/academia/calidad-de-vida-en-pacientes-con-artropatia-de-manguito-rotador/

QUALITY OF LIFE IN PATIENTS WITH ROTATOR CUFF ARTHROPATHY

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29375259

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782863/

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-78522017000600275&lng=en&tlng=en

De:

Ferreira AA NETO1, Malavolta EA1, Assunção JH1, Gracitelli MEC1, Ocampos GP1, Trindade EM2.

Acta Ortop Bras. 2017 Nov-Dec;25(6):275-278. doi: 10.1590/1413-785220172506173893.

Todos los derechos reservados para:

Author information ► Article notes ► Copyright and License information ▼

Copyright notice

 This is an open-access article distributed under the terms of the Creative Commons Attribution License

Abstract

Objective:

To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales.

Conclusion:

Patients with rotator cuff arthropathy had poorer results for the physical component of the SF-12 than the controls. They also had poorer functional results according to the ASES scale, and more pain according to the VAS. Level of Evidence III, Case Control Study.

KEYWORDS:

Arthroplasty; replacement. Joint diseases. Osteoarthritis. Rotator cuff. Quality of life.

Resumen

Objetivo:

Comparar la calidad de vida (según el SF-12) en pacientes con artropatía del manguito de los rotadores con controles emparejados por sexo y edad. Los objetivos secundarios son comparar los grupos según las escalas ASES y VAS.

Conclusión:
Los pacientes con artropatía del manguito rotador tuvieron peores resultados para el componente físico del SF-12 que los controles. También tuvieron peores resultados funcionales según la escala ASES y más dolor de acuerdo con la escala VAS. Nivel de evidencia III, Estudio de control de casos.

Revisión y presentación clínica en artroplastia reversa de hombro en parálisis deltoidea

http://www.lesionesdeportivas.com.mx/academia/revision-y-presentacion-clinica-en-artroplastia-reversa-de-hombro-en-paralisis-deltoidea/

Review and clinical presentation in reverse shoulder arthroplasty in deltoid palsy

Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29372328

https://link.springer.com/article/10.1007%2Fs00590-018-2126-x

De:

Kermarrec G1, Werthel JD2, Canales P3, Valenti P2.

Eur J Orthop Surg Traumatol. 2018 Jan 25. doi: 10.1007/s00590-018-2126-x. [Epub ahead of print]

Todos los derechos reservados para:

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Abstract

Deltoid palsy is a classical contraindication for reverse shoulder arthroplasty (RSA). However, in cases associating axillary nerve palsy and rotator cuff tear or glenohumeral arthritis, few options remain. We present a case in which combining RSA with transfer of the pectoralis major and upper and middle trapezius transfer provided satisfactory results in a patient suffering of both an irreparable rotator cuff tear and a deltoid palsy.Level of evidence IV.

KEYWORDS:

Axillary nerve palsy; Deltoid palsy; Pectoralis major; Rotator cuff tear; Shoulder arthroplasty; Tendon transfer; Trapezius

Resumen

La parálisis deltoides es una contraindicación clásica para la artroplastia reversa de hombro  (RSA). Sin embargo, en casos que asocian parálisis del nervio axilar y rotura del manguito rotador o artritis glenohumeral, quedan pocas opciones. Presentamos un caso en el que la combinación de RSA con la transferencia del pectoral mayor y la transferencia del trapecio superior y medio proporcionaron resultados satisfactorios en un paciente que sufría tanto una rotura irreversible del manguito de los rotadores como una parálisis deltoidea. Nivel de evidencia IV.

PALABRAS CLAVE:

Parálisis del nervio axilar; Parálisis deltoidea; Pectoral mayor; Desgarro del manguito rotador; Artroplastia de hombro; Transferencia de tendones; Trapecio

PMID: 29372328  DOI:  10.1007/s00590-018-2126-x

Luxación y/o dislocación después del reemplazo total de cadera

www.reemplazoprotesico.com.mx/academia/luxacion-y-o-dislocacion-despues-del-reemplazo-total-de-cadera/

Dislocation after Total Hip Replacement

Fuente

Este artículo y/o video es originalmente publicado en:

https://youtu.be/Mu-987khgw4


De y todos los derechos reservados para:

Courtesy: Dr Shekhar Agarwal, Sant Paramanand Hospital, NewDelhi

Dr. Shekhar Agarwal – Best Knee and Hip Replacement Surgeon

Dr. Shekhar Agarwal India’s best Knee, Hip and Joint Replacement surgeon Guiding to orthopaedic Surgeons on Dislocation in Total Hip Replacement. Dr.Shekhar Agarwal is Chief Surgeon and Head of Joint Replacement Surgery at Delhi Institute of Trauma and Orthopaedics, Sant Parmanand Hospital. He has 30 years of active clinical practice as a knee and hip replacement surgeon. He also serves as faculty for knee and hip lectures across India and abroad.This video is intended to give orthopaedic surgeons, caregivers as well as medical professionals a complete understanding of total hip replacement surgery, as well as other orthopaedic procedures.

Categoría

Ciencia y tecnología

Licencia

Licencia de YouTube estándar

Las caídas son de las principales causas de problemas en las articulaciones, especialmente en hombro y codo.

http://www.mihombroycodo.com.mx/academia/las-caidas-son-de-las-principales-causas-de-problemas-en-las-articulaciones-especialmente-en-hombro-y-codo/

Las caídas son de las principales causas de problemas en las articulaciones, especialmente en hombro y codo.

Te invito a informarte en https://www.hombroycodo.com.mx/single-post/caer-evitar-lesiones sobre algunas técnicas para evitar o reducir el daño tras un tropiezo o caída común en tu vida diaria.

¡Que tengas un excelente inicio de semana!

Anestesia regional y cáncer / Regional anesthesia and cancer

Enero 29, 2018. No. 2978

Relación entre anestesia regional y cáncer. Un meta-análisis The Relationship Between Regional Anesthesia and Cancer: A Metaanalysis. Grandhi RK, Lee S, Abd-Elsayed A. Author information Ochsner J. 2017 Winter;17(4):345-361. Abstract BACKGROUND: Some studies have suggested using epidural analgesia after cancer surgery to reduce metastasis. This article examines the relationship between regional anesthesia (RA) and cancer metastasis in an array of cancers. METHODS: We conducted a review of the literature using PubMed and included 67,577 patients across 28 studies in a metaanalysis, evaluating the hazard ratios (HRs) of overall survival, recurrence-free survival, and biochemical recurrence-free survival. RESULTS: We found no benefit to RA as it relates to cancer. The HR was 0.92 for overall survival, 1.06 for recurrence-free survival, and 1.05 for biochemical recurrence-free survival. Despite the overall analysis showing no benefit, we found some benefit when we evaluated only the randomized trials. However, we found no significant benefit of RA when we evaluated the cancers (gastrointestinal, prostate, breast, and ovarian) individually. CONCLUSION: This metaanalysis shows that RA has no overall survival, recurrence-free survival, or biochemical recurrence-free survival benefit. However, some individual studies have shown significant benefit in terms of cancer recurrence. Further, RA reduces the use of opioids, which has led to some secondary benefits. Further studies are needed to establish the benefits of RA as it relates to cancer. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org