Avanços em Farmacoepidemiologia e Segurança de Medicamentos

Abstrato

Um estudo inovador de anestesia por infiltração local e nova técnica para alívio eficaz da dor após substituição primária eletiva da anca e do joelho

Mohammad Salhab

Enquadramento:   O controlo da dor aguda após próteses totais do joelho (TKRs) eletivas essenciais e próteses totais da anca (THRs) é frequentemente deficiente e está associado à perturbação de dor incessante de longa duração. A agonia moderada a grave é regularmente relatada nas primeiras 48 horas após o procedimento médico, exigindo diversas metodologias de tormento, as metodologias do conselho, por exemplo, ausência de dor controlada persistente e ausência de dor tranquilizante multimodal. A técnica de infiltração anestésica local (LIA) é atualmente um método estabelecido para lidar com a dor perioperatória; no entanto, considera ter evidências contraditórias detalhadas até ao momento. Numa pesquisa contínua de 29 exames que exploram a utilização de LIA em TKR, o LIA desenvolveu-se como um procedimento protegido com melhor controlo da agonia (Gibbs DMR 2012). Construímos o método LIA para incorporar um cateter intra-articular permitindo que uma imersão de Novel Mixture (NM) seja misturada persistentemente no pós-operatório. A ausência preventiva de dor, um tratamento antinociceptivo, é o tratamento iniciado antes do procedimento médico com o objetivo de evitar o agravamento do tormento evocado pelo corte relacionado e pelas feridas de fogo que ocorrem durante o procedimento médico. Para além do direcionamento antes do procedimento médico, o Pre-Emptive Ausência de Dor pode ser utilizado no pós-operatório imediato. Este impacto defensivo é dado pela ausência preventiva de dor no quadro nociceptivo. Para diminuir a sensação de agonia, a escrita registou algumas metodologias, entre as quais medicamentos e cursos.

 

Joint substitution medical procedures are considered as one of the most excruciating orthopedic techniques. This excruciating method is the aftereffect of lacking and inadequately rewarded postoperative torment after significant joint substitution medical procedure. This agony scene must be ideal tended to in light of the fact that not exclusively does this fundamentally drag out the restoration procedure, yet in addition purposes the expanded danger of different inconveniences. If not tended to inside time or without legitimate methodology, these postoperative excruciating scenes can advance into constant torment, which in the long run drags out the general length of hospitalization and cost. The excursion to accomplish the total and long haul help with discomfort starts before the medical procedure is performed. A significant premise to accomplish long haul help with discomfort and practical recuperation after the joint medical procedure includes adequate peri-employable absense of pain. One of the significant angles to accomplish effective result after joint medical procedure is the early joint preparation with the commencement of non-intrusive treatment. A few new medications and novel procedures to enhance the post-employable agony post-medical procedure are being presented each year, yet the greater part of the patients despite everything wind up experiencing extraordinary torment following medical procedure which frequently advances into constant torment.  Arthroscopic knee medical procedure has gotten progressively well known in present day orthopedics. In any case, the post-employable knee torment the board including early help and agony free postoperative consideration to the patient stays a test to a few clinicians. Now and again, torment the board in itself has become a need for the board as a childcare methodology. Tenacious agony after knee arthoplasty stays an uncertain issue for some patients. Torment is considered as an exceptionally emotional occasion since everybody has an alternate recognition and edge of agony. What's more, hence, it turns out to be hard to normalize any agony system for a specific medical procedure. A few factors that cause knee torment, which incorporate aggravation of free sensitive spots of the joint case, synovial tissue, front fat cushion.

The point of neighborhood penetration is to anesthetize sensitive spots in a limited territory of tissue by the infusion of neighborhood sedatives close by. This stands as opposed to fringe nerve obstructs, in which nerve axons are the objective and the infusion may occur in a region expelled from the careful site (eg, brachial plexus hinder for hand medical procedure). The profundity of the region to be worked on commonly decides the necessary degree of invasion. For shallow skin methods, for example, stitching of slashes and skin biopsies, subcutaneous or intradermal penetration is adequate. Increasingly broad tasks may request invasion into muscle, belt, and other profound tissues. Two general methodologies exist for anesthetizing skin and subcutaneous tissue. The first includes infusing neighborhood sedative legitimately into the line of cut and close by tissues, successfully flooding the individual nearby sensitive spots to deliver sedation. This can be exceptionally successful, yet may require huge volumes of neighborhood sedative to accomplish total inclusion.

Aims and Objectives:

In this study we find out the results on our experience using LIA in addition to the Novel Techniques and Proprietary NM developed in Leeds-Bradford and infiltrated at 4-5 mls/hour for 48 hours post surgery.

Materials and Methods:

Between October 2013 and October 2015, 62 patients undergoing primary TKR were prospectively followed up. Three groups of patients were studied. All patients studied had spinal anaesthesia (SA) with 300-400mcg diamorphine.

Group 1.  GA. No LIA and no NM. 20 patients.

Group 2.   SA plus NM for 48 hours post operatively with catheter placed anteriorly under the patella.  21 patients.

Group 3.  SA plus LIA plus NM for 48 hours post operatively with catheter placed posteriorly in the knee joint.  21 patients.

Between June 2011 and July 2014, 173 consecutive patients undergoing primary THR using the posterior approach were also prospectively followed up.

Results and complications: 

The patients without LIA or NM required more morphine in the initial 12 hours postoperative period than different gatherings. 70% (n=14) of these gathering 1 patients required 10mg morphine following TKR contrasted with just 2% (n=1) of patients requiring 10mg of morphine when LIA and NM were utilized. The expanded morphine necessity proceeded for 48 hours postoperatively in bunch 1, while none of the patients in bunches 2 or 3 required morphine following 36 hours. Factual investigation uncovered no distinction of morphine necessities with various catheter situation. Less patients experienced sickness and heaving or urinary maintenance in the gathering with LIA and NM (p-esteem <0.05, Mann-Whitney test). There were no contaminations DVT or different difficulties in any of the gatherings.

Conclusion:

Esta investigação mostra que os doentes após ATJ foram recompensados ​​com LIA e NM durante 48 horas após necessitarem de fundamentalmente menos morfina durante este período. Esta vantagem era geralmente concedida nas primeiras 24 horas após o procedimento médico e a vantagem era mantida durante 48 horas. Menos doentes necessitaram de ausência de dor sedativa quando foram utilizados LIA e NM, em comparação com outros grupos. A centralidade mais notável foi no horário das 0-12 horas para os doentes que necessitaram de utilizar até 20mg de morfina (χ2(2) = 46,713, p = 0,000); e 0-12h para doentes que necessitem de utilizar 30mg de morfina (χ2(2)=46,310,p=0,000).