Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

Moderate or severe pain are important sources of complications as well as morbidity and mortality in the postoperative period after surgical procedures. Patient‐controlled analgesia (PCA) is an effective strategy for postoperative analgesia, since it may provide suitable analgesic dose just after system activation, with reduced periods of pain and an increase in patients’ satisfaction. Although intravenous and epidural routes are the typical approaches used for PCA, regional patient‐controlled analgesia has been shown to be an effective alternative providing a higher standard of analgesia with lower incidence of adverse effects. New devices and routes of PCA administration (transdermal, sublingual, inhalation, and oral routes) have shown to be promising alternatives in clinical studies. Nowadays, there is still no consensus regarding which is the best route or drug used since clinical efficacy/safety depends on the complex comprehension of the drugs pharmacokinetic profile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost‐effectiveness of these approaches

Avaliação da funcionalidade de idosos com osteoartrite utilizando o Lower Extremity Functional Scale (LEFS)

Introdução: A osteoartrite é uma doença crônico-degenerativa muito prevalente em idosos, a qual desencadeia limitações funcionais e pior qualidade de vida. Embora existam questionários para avaliação da funcionalidade destes pacientes, a busca por instrumentos específi cos para avaliação de membros inferiores apresenta relevância na prática fi sioterapêutica. Objetivos: Avaliar a correlação do Lower Extremity Functional Scale (LEFS) com a funcionalidade e componentes físicos e mentais da qualidade de vida em idosos com osteoartrite. Método: Estudo transversal, no qual a funcionalidade foi avaliada pelos questionários WOMAC, Lequesne e LEFS e a qualidade de vida foi avaliada pelo questionário SF-36. Resultados: Participaram do estudo 105 idosos (Idade: 68,80± 6,3 anos) com osteoartrite de joelho ou quadril, sendo 31homens e 74 mulheres. Não foi observada associação entre a idade (p>0,05) e o comprometimento funcional avaliado tanto pelo índice WOMAC quanto Lequesne (p>0,05) na população estudada. Foi observada correlação negativa entre o indice WOMAC e o LEFS (rS=-0,81) e o Lequesne e o LEFS (rS=-0,86). Além disso, foi verifi cada associação entre os escores do LEFS e a capacidade funcional (rS=0,80), limitação por aspectos físicos (rS=0,44), dor (rS=0,55) e estado geral de saúde (rS=0,44). Ainda, foi verifi cada correlação entre o escore do LEFS e a vitalidade (rS=0,60), aspectos sociais (rS=0,38), limitação por aspectos emocionais (rS=0,38) e saúde mental (rS=0,41). Conclusão: Concluise que o LEFS apresenta boa correlação com os índices WOMAC e Lequesne e com os componentes físicos e mentais da qualidade de vida, podendo constituir um instrumento clínico para avaliação do impacto funcional da osteoartrite em idosos. Introduction: Osteoarthritis is a chronic degenerative disease very prevalent in the elderly, which triggers functional limitations and poorer quality of life. Although there are already established instruments to evaluate the functional status of these patients, the search for specific instruments for assessment of lower limbs has relevance in physical therapy practice. Objective: This study aimed to evaluate the correlation between LEFS with functional status and physical and mental components of quality of life of older adults with osteoarthritis. Methods: At this cross-sectional study, the functional status was assessed by WOMAC, Lequesne and LEFS indexes and the quality of life was assessed by SF-36. Results: This study included 105 elderly (age: 68.80 ± 6.3 years) with osteoarthritis of the knee or hip, being 31 men and 74 women. It was not observed a correlation between age and functional status (p>0.05) analyzed by WOMAC and Lequesne indexes. However, negative correlations between WOMAC and LEFS(rS=- 0.81) as well as Lequesne and LEFS(rS= -0.86) were observed according to Spearman’s correlation. Moreover, there was a correlation between the LEFS’ score and functional capacity (rS = 0.80), limitation by physical aspects (rS= 0.44), pain (rS= 0.55) and general health (rS = 0.44). Moreover, it was also observed a positive correlation between the LEFS’ score and vitality (rS=0.60), social status (rS= 0.38), limitation for emotional aspects (rS=0.38) and mental health (rS= 0.41). Conclusion: LEFS correlates well with the WOMAC and Lequesne indexes as well as the physical and mental components of quality of life and it may be an alternative clinical tool for assessing the functional impact of osteoarthritis in the elderly

Gabapentinoids in Preventive Analgesia: Pharmacological and Clinical Aspects

Optimal postoperative pain management presents a challenge for healthcare providers across all surgical specialties, since it is estimated that many patients submitted to major surgeries do not receive an adequate analgesic treatment, increasing the risk of complications, length-of-stay and costs for health assistance. The development of new agents for postoperative pain control creates possibilities for better combinations in preventive and multimodal analgesia. Recently, the use of gabapentinoids (gabapentin and pregabalin) in the perioperative period has become more popular. Several clinical studies and meta-analyses reveal that perioperative gabapentinoids may evoke a significant opioid-sparing effect and probably decrease the postoperative pain score. Gabapentinoids may be a good strategy for preventive and multimodal analgesia in major surgeries, particularly pregabalin, considering its pharmacokinetics profile. Situations where there are limitations of regional anesthesia techniques or in cases where there is an intention to reduce the use of opioids or anti-inflammatory drugs at the trans-operatory period are certainly good opportunities for their use. However, gabapentinoids are associated with several adverse effects, including sedation, dizziness, and peripheral edema. Therefore, further studies are needed to evaluate the real cost-effectiveness of this approach. Additionally, specific attention should be paid to minor and ambulatory surgeries as well as for the elderly patients to which gabapentinoids are clearly not beneficial and potentially harmful

ANALYSIS OF FUNCTIONAL CAPACITY IN INDIVIDUALS WITH AND WITHOUT CHRONIC LOWER BACK PAIN

<div><p>ABSTRACT Objective: The objective of this study was to analyze the functional status of adult and older adult individuals with lower back pain . Methods: Eighty-three individuals were recruited, 42 older adults (20 with lower back pain and 22 control group) and 41 younger adults (21 with lower back pain and 20 control group). Functional capacity was assessed using the following tests: Timed Up and Go (TUG), Five Times Sit-to-Stand (FTSTS), six-minute walking test (SMWT), and sitting-rising test (SRT) . Results: In the younger adults, there was no difference in functional capacity between the groups (p>0.05). On the other hand, when statistical analysis was adjusted using body mass index (BMI) as a covariate, the lower back pain group performed more poorly on the SRT (p<0.004). Furthermore, poorer physical capacity was seen in the older adults with back pain via the SRT test (p=0.001), and when the BMI was adjusted, a statistical difference was seen in the SRT as well as the SMWT (p<0.05) . Conclusion: Older individuals with lower back pain have poorer physical performance, and the sitting-rising test is the most discerning for assessment of functional status in individuals with lower back pain. Level of Evidence III, Retrospective Comparative Study.</p></div