RESUMO
Introdução: o diagnóstico da dor sentida pela criança é um passo importante para orientar o cirurgião-dentista sobre o uso de técnicas farmacológicas e não farmacológicas que minimizem a sensação desagradável. Objetivo: identificar os instrumentos usados para a avaliação da dor de crianças pré-escolares durante procedimentos odontológicos. Fontes dos dados: busca por artigos foi realizada no PubMed, Scopus, The Cochrane Library e Google Schoolar, em abril/2022. Estudos observacionais e de intervenção que avaliaram a dor de crianças pré- escolares em atendimento odontológico, publicados em português, inglês ou espanhol foram incluídos. Estudos que avaliaram a dor de crianças tratadas sob sedação ou anestesia geral, bem como a dor pós-operatória, foram excluídos. Síntese dos dados: um total de 767 artigos foram identificados; 133 artigos foram lidos integralmente e 62 incluídos. Em 48 estudos, a dor foi avaliada por meio de autorrelato, usando instrumentos como a Wong-Baker FACES Pain Rating Scale e outras escalas de faces como a Faces Pain Scale-Revised e a Faces Pain Scale. Quando a dor foi avaliada a partir do comportamento infantil, foram usadas escalas como a Face, Legs, Activity, Cry, Consolability Scale (FLACC) e a Sound, Eye and Motor scale (SEM). Conclusão: a dor processual das crianças foi avaliada por meio de autorrelato e da observação do seu comportamento. Tanto as escalas de autorrelato quanto as observacionais têm limitações. A combinação dos instrumentos pode ser uma estratégia na avaliação da dor de pré-escolares.
Introduction: the diagnosis of the pain felt by the child is an important step to guide the dentist on the use of pharmacological and non-pharmacological techniques that minimize unpleasant sensation. Objective: to identify the instruments used to assess the pain of preschool children during dental procedures. Sources of Data: search for articles was conducted at PubMed, Scopus, The Cochrane Library and Google Schoolar in April/2022. Observational and interventional studies that evaluated the pain of preschool children in dental care, published in Portuguese, English or Spanish were included. Studies evaluating the pain of children treated under sedation or general anesthesia, as well as postoperative pain, were excluded. Synthesis of data: a total of 767 articles were identified; 133 articles were read in full and 62 included. In 48 studies, pain was evaluated by self-report, using instruments such as the Wong-Baker FACES Pain Rating Scale and other face scales such as the Faces Pain Scale-Revised and the Faces Pain Scale. When pain was evaluated from child behavior, scales such as Face, Legs, Activity, Cry, Consolability Scale (FLACC) and Sound, Eye and Motor scale (SEM) were used. Conclusion: the procedural pain of the children was evaluated by self-report and the observation of their behavior. Both self-report and observational scales have limitations. The combination of the instruments can be a strategy in the evaluation of the pain of preschoolers.
Assuntos
Pré-Escolar , Medição da Dor , Dor Processual , Assistência Odontológica , Dor Processual/diagnóstico , Dor Processual/tratamento farmacológicoRESUMO
Naproxen is a widely used non-steroidal anti-inflammatory drug for the control of postoperative inflammatory signs and symptoms in dentistry. Its association with esomeprazole has been widely studied and has yielded good results for the control of acute pain, even with the delayed absorption of naproxen owing to the presence of esomeprazole. To further understand the absorption, distribution, and metabolism of this drug alone and in combination with esomeprazole, we will analyze the pharmacokinetic parameters of naproxen and its major metabolite, 6-O-desmethylnaproxen, in saliva samples. A rapid, sensitive, and selective liquid chromatography-tandem mass spectrometric method for the simultaneous determination of naproxen and 6-O-desmethylnaproxen in saliva will be developed and validated. Sequential saliva samples from six patients will be analyzed before and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5, 6 8, 11, 24, 48, 72, and 96 h after the ingestion of one naproxen tablet (500 mg) and esomeprazole-associated naproxen tablets (500 + 20 mg), at two different times. After liquid-liquid extraction with ethyl acetate and HCl, the samples will be analyzed using an 8040 Triple Quadrupole Mass Spectrometer (Shimadzu, Kyoto, Japan). Separation of naproxen and its major metabolic products will be performed using a Shim-Pack XR-ODS 75Lx2.0 column and C18 pre-column (Shimadzu, Kyoto, Japan) at 40°C using a mixture of methanol and 10 mM ammonium acetate (70:30, v/v) with an injection flow of 0.3 mL/min. The total analytical run time will be 5 min. The detection and quantification of naproxen and its metabolite will be validated, which elucidate the pharmacokinetics of this drug, thereby contributing to its proper prescription for the medical and dental interventions that cause acute pain.
Assuntos
Anti-Inflamatórios não Esteroides/farmacocinética , Monitoramento de Medicamentos/métodos , Esomeprazol/farmacocinética , Naproxeno/análogos & derivados , Saliva/química , Administração Oral , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/isolamento & purificação , Cromatografia Líquida de Alta Pressão/métodos , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Esomeprazol/administração & dosagem , Esomeprazol/isolamento & purificação , Feminino , Absorção Gastrointestinal , Humanos , Masculino , Metanol/química , Pessoa de Meia-Idade , Naproxeno/administração & dosagem , Naproxeno/isolamento & purificação , Naproxeno/farmacocinética , Dor Processual/tratamento farmacológico , Reprodutibilidade dos Testes , Comprimidos , Espectrometria de Massas em Tandem/métodos , Adulto JovemRESUMO
PURPOSE: The aim of the study was to evaluate the effectiveness of fentanyl pectin nasal spray (FPNS) in controlling procedural breakthrough cancer pain (BTCP) in advanced cancer patients undergoing radiotherapy. MATERIALS AND METHODS: This study involved 62 advanced cancer patients, with well-controlled background pain, who presented BTCP associated to routine radiotherapy procedures, treated with FPNS according to our protocol of administration. The BPE intensity was measured using a visual analog scale (VAS). RESULTS: The BTCP was triggered during the computed tomography simulation (79.3%) or treatment delivery (20.7%). Patients indicated a mean VAS of 8.8 (range 7-10) when attempting the procedure. After 4.5 min (range 2-10) of the first FPNS dose, the majority of patients (85.5%) indicated a VAS of 4.3 (range 2-6). 15.5% of the patients did not respond after 15 min; requiring a second dose. All these patients responded, reporting a mean VAS of 4.2 (range 4-6) after 3.0 min (range 2-5) of the second dose. None of the patients required a third dose, nor reported an AE after the administration of FPNS. CONCLUSIONS: In our knowledge, our study is the one of highest recruitment, and with the fastest response of BTCP treated with FPNS reported in advanced cancer patients undergoing radiotherapy. FPNS has proven to be highly effective in reducing the intensity of procedural BTCP in a very short period of time.
Assuntos
Analgésicos Opioides/administração & dosagem , Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Fentanila/administração & dosagem , Neoplasias/radioterapia , Dor Processual/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Irruptiva/etiologia , Dor do Câncer/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sprays Nasais , Medição da Dor , Dor Processual/complicações , Radioterapia/efeitos adversosRESUMO
INTRODUCTION: Acute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics. OBJECTIVE: To review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain. METHODS: Medline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements. RESULTS: From 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension. CONCLUSION: Dexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.
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Dor Aguda/tratamento farmacológico , Analgésicos não Narcóticos/uso terapêutico , Dexmedetomidina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Processual/tratamento farmacológico , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos TestesRESUMO
Abstract Introduction: Acute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics. Objective: To review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain. Methods: Medline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements. Results: From 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension. Conclusion: Dexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.
Assuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Analgésicos não Narcóticos/uso terapêutico , Dexmedetomidina/uso terapêutico , Esternotomia/efeitos adversos , Dor Aguda/tratamento farmacológico , Dor Processual/tratamento farmacológico , Toracotomia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Cardíacos/efeitos adversosRESUMO
INTRODUCTION: Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50-50% N2O-O2 gas mixture on pain intensity in these patients. MATERIAL AND METHODS: Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50-50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. RESULTS: Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0-10) vs 5.95 (0-10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. CONCLUSION: The 50-50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Biópsia Guiada por Imagem , Óxido Nitroso/uso terapêutico , Oxigênio/uso terapêutico , Dor Processual/tratamento farmacológico , Próstata/cirurgia , Administração por Inalação , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/efeitos adversos , Método Duplo-Cego , Gases/efeitos adversos , Gases/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Oxigênio/efeitos adversos , Medição da Dor , Satisfação do Paciente , Próstata/diagnóstico por imagem , Próstata/patologia , Reto/diagnóstico por imagem , Reto/cirurgia , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
OBJECTIVES: Lumbar punctures (LPs) are commonly performed in febrile infants to evaluate for meningitis, and local anesthesia increases the likelihood of LP success. Traditional methods of local anesthesia require injection that may be painful or topical application that is not effective immediately. Recent advances in needle-free jet injection may offer a rapid alternative to these modalities. We compared a needle-free jet-injection system (J-Tip) with 1% buffered lidocaine to topical anesthetic (TA) cream for local anesthesia in infant LPs. METHODS: This was a single-center randomized double-blind trial of J-Tip versus TA for infant LPs in an urban tertiary care children's hospital emergency department. A computer randomization model was used to allocate patients to either intervention. Patients aged 0 to 4 months were randomized to J-Tip syringe containing 1% lidocaine and a placebo TA cream or J-Tip syringe containing saline and TA. The primary outcome was the difference between the Neonatal Faces Coding Scale (NFCS) before the procedure and during LP needle insertion. Secondary outcomes included changes in heart rate (HR) and NFCS throughout the procedure, difficulty with LP, number of LP attempts, provider impression of pain control, additional use of lidocaine, skin changes at LP site, and LP success. RESULTS: We enrolled 66 subjects; 32 were randomized to J-Tip with lidocaine and 34 to EMLA. Six participants were excluded from the final analysis due to age greater than 4 months, and the remaining 58 were analyzed in their respective groups (32 J-Tip, 34 TA). There was no difference detected in NFCS between the two treatment groups before the procedure and during needle insertion for the LP (p = 0.58, p = 0.37). Neither HR nor NCFS differed among the groups throughout the procedure. Median perception of pain control by the provider and the need for additional lidocaine were comparable across groups. LPs performed with a J-Tip were twice as likely to be successful compared to those performed using TA (relative risk = 2.0; 95% confidence interval = 1.01-3.93; p = 0.04) with no difference in level of training or number of prior LPs performed by providers. CONCLUSIONS: In a randomized controlled trial of two modalities for local anesthesia in infant LPs, J-Tip was not superior to TA cream as measured by pain control or physiologic changes. Infant LPs performed with J-Tip were twice as likely to be successful.
Assuntos
Anestésicos Locais/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Lidocaína/administração & dosagem , Dor Processual/tratamento farmacológico , Punção Espinal/métodos , Administração Tópica , Criança , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Injeções/métodos , Masculino , Agulhas , Medição da Dor/métodosRESUMO
ABSTRACT The present study aimed to perform a systematic literature review to determine if there is a non-steroidal anti-inflammatory drug (NSAID) that interferes less within tooth movement. This research was performed according to the PRISMA statement. Articles were searched in eight electronic databases (PubMed, Scopus, Embase, Web of Science, LILACS, SciELO, Google Scholar, and Open Grey). Only experimental studies on male Wistar rats were selected, which included experiments related to the influence of NSAIDs on orthodontic movement. Studies in animals with pathological conditions, literature review articles, letters to the editor and/or editorials, case reports, abstracts, books, and book chapters were excluded. Each of the steps of this systematic literature review was performed by two examiners independently. Results: the total sample consisted of 505 articles, from which 6 studies were eligible after a qualitative analysis. From the drugs assessed, paracetamol was unanimous for not interfering within orthodontic movement when compared to the control group. However, drugs such as aspirin, ibuprofen, sodium diclofenac, and selective cyclooxygenase-2 inhibitors caused a reduction in tooth movement when compared to the control group. Conclusion: paracetamol could be considered the drug of choice for pain relief because it interferes less within tooth movement.
Assuntos
Animais , Ratos , Técnicas de Movimentação Dentária/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacologia , Ibuprofeno/farmacologia , Analgésicos não Narcóticos/farmacologia , Dor Processual/tratamento farmacológico , Acetaminofen/farmacologia , Ratos Wistar , Modelos Animais de DoençasRESUMO
The present study aimed to perform a systematic literature review to determine if there is a non-steroidal anti-inflammatory drug (NSAID) that interferes less within tooth movement. This research was performed according to the PRISMA statement. Articles were searched in eight electronic databases (PubMed, Scopus, Embase, Web of Science, LILACS, SciELO, Google Scholar, and Open Grey). Only experimental studies on male Wistar rats were selected, which included experiments related to the influence of NSAIDs on orthodontic movement. Studies in animals with pathological conditions, literature review articles, letters to the editor and/or editorials, case reports, abstracts, books, and book chapters were excluded. Each of the steps of this systematic literature review was performed by two examiners independently. RESULTS: the total sample consisted of 505 articles, from which 6 studies were eligible after a qualitative analysis. From the drugs assessed, paracetamol was unanimous for not interfering within orthodontic movement when compared to the control group. However, drugs such as aspirin, ibuprofen, sodium diclofenac, and selective cyclooxygenase-2 inhibitors caused a reduction in tooth movement when compared to the control group. CONCLUSION: paracetamol could be considered the drug of choice for pain relief because it interferes less within tooth movement.
Assuntos
Acetaminofen/farmacologia , Analgésicos não Narcóticos/farmacologia , Anti-Inflamatórios não Esteroides/farmacologia , Ibuprofeno/farmacologia , Dor Processual/tratamento farmacológico , Técnicas de Movimentação Dentária/efeitos adversos , Animais , Modelos Animais de Doenças , Ratos , Ratos WistarRESUMO
OBJECTIVE: To assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. METHODS: Sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. RESULTS: The groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47). The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. CONCLUSION: The present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious.