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Background: Audio-analgesia, the ability of music to reduce the perception of pain, has been a significant field of research in the past decade. This study aimed to investigate the impact of the musical constructs of harmonicity and rhythmicity on acute, post-operative pain. Method: 98 patients scheduled for primary total knee arthroplasty were randomly allocated at their pre-admissions clinic to one of four music listening groups, receiving commercially-available music. The participants in the experimental groupings were randomised according to the musical constructs of high/low harmonicity and rhythmicity (four possible groups; + +, + –, – +, – –). Music groups were compared against a silent control group, receiving quiet relaxation (with headphones). After surgery using a standardised anaesthetic regiment, all participants undertook a 15-minute listening/ silent intervention on the ward for each day of their in-patient stay (max. 5 days). The primary endpoint was pain intensity. Salivary cortisol concentrations and mood stability were also monitored. Qualitative data was collected via daily feedback and assessed through thematic category analysis. Results: A significant reduction in pain intensity from pre- to post-test was shown for all participants (p < 0:0005), but with no difference between groups (F(4;68) = 1:331, NS). Quiet relaxation (mean change: 22.27%) was as effective as music listening (mean change: 37.47%). Salivary cortisol concentrations showed an interaction between music with high harmonicity and high rhythmicity (+ +) and music of low harmonicity and rhythmicity (– –). + + music reduced cortisol concentration to a greater extent on Day 1 (p < :05) than – – music. There was no significant difference between groups in mood disturbance. Qualitative data revealed four thematic categories of response: psychological, physiological, musicological and methodological, overall indicating that patients utilised their intervention as a distracting and relaxing cognitivecoping strategy. Conclusion: Music is a viable therapeutic medium which reduced pain, as effectively as quiet relaxation. Compositional constructs were minimally active in the degree of analgesia and physiological changes experienced by patients, but where this did occur, it could be related to Berlyne’s inverted-U model of musical preference (Berlyne, 1971). The positive reception of the interventions and the associated benefits, supports the inclusion of cognitive-coping strategies in multi-modal care pathways.

Objetivo: Determinar la eficacia analgésica y sedativa de la dexmedetomidina así como la seguridad de la administración de la misma en pacientes postoperados Metodología: Se diseño un estudio descriptivo, serie de casos, longitudinal, prospectivo a simple ciego, la muestra incluyo 25 pacientes (relacionado al costo de la droga y la dificultad para su obtención) que cumplieron con los criterios de inclusión: a.- Edad: 18 a 65 años. b.- Pacientes ASA I – II c.- Pacientes sometidos a anestesia general operados de colecistectomía laparoscópica d.- Pacientes que no presenten alergia conocida a cualquiera de los medicamentos usados dentro del protocolo del estudio Un observador vigilo el cumplimiento del protocolo intraoperatorio y otro monitorizo y registro los valores relacionados a cambios hemodinámicos y ventilatorios, así como los valores de EVA para el dolor y Ramsay para sedación en la Unidad de Recuperación post-Anestésica. Los datos obtenidos fueron ingresados a una hoja de cálculo en Excel y procesados y analizados con el programa SPSS Resultados: Un 92% de los pacientes estaban comprendidos entre los 40 y 65 años, la mitad de ellos comprendidos en cada sexo 52% masculino y 48% femenino. En relación a la eficacia analgésica se observó una disminución progresiva de los valores de EVA a medida que se desarrollaba la infusión, sin embargo un 40% de los pacientes fue necesario un complemento analgésico con opioide para alcanzar el objetivo analgésico (EVA menor de 4). En relación a la eficacia sedativa se observó una progresiva profundidad en los niveles de sedación destacándose sin embargo la cualidad de “sedación activa” descrita para la droga. En relación a la seguridad de la administración se evidencian cambios predecibles de la frecuencia cardiaca: bradicardia en un 80% de los pacientes, que responden fácilmente a la administración de atropina. Se observó además hipotensión en 20% de los casos, no siendo necesario en ningún caso el uso de vasopresores. No se evidencia depresión ventilatoria en ningún caso. Conclusiones: La infusión de dexmedetomidina por sí misma no evidencia ser suficiente para aliviar el dolor de los pacientes sometidos al estudio probablemente disminuya los requerimientos de analgésicos opioides. La eficacia sedativa ha sido demostrada. Así mismo se demuestra que la droga es segura con la dosis administrada en el presente estudio.

Made available in DSpace on 2019-03-30T00:18:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-04-28 / The humanized delivery, which is in increasing evidence in the last 50 years in Brazil, has analgesia as one of its pillars. The main objective of this research was to search for pharmaco-logical alternatives to continuous epidural to alleviate severe pain in labor, which produce great maternal suffering and may alter the outcome of labor. A very marked uterine activity can modify the effectiveness of the contractions, creating difficulties during childbirth. Two groups were followed: the first received small doses of pethidine (0.25 mg/kg) and the second group received usual doses of sodium dipyrone (25 mg/kg) during the active phase of labor, with the cervix dilated at least 5 centimeters. The research medications were administered once and intravenously. The 200 parturients of the research presented intense pains. The pain was assessed by the visual analogue scale in three different moments: before, one hour and two hours after administration of the analgesics. The expectation on was that one of the drugs was superior to the other. Analysis of the results showed that the two drugs have equivalent potency during labor, in which the analgesic action occurred only during the first hour after the intervention. There were no differences in adverse effects. KEYWORDS: Analgesia; Humanizing delivery. / O parto humanizado, que se encontra em crescente evidência nos últimos 50 anos no Brasil, tem a analgesia como um de seus pilares. O objetivo principal desta pesquisa foi buscar alter-nativas farmacológicas à peridural contínua, para amenizar os quadros álgicos intensos do trabalho de parto, que produzem grande sofrimento materno e podem alterar o desfecho do parto. Uma atividade uterina muito acentuada pode modificar a efetividade das contrações, criando dificuldades durante o parto. Foram acompanhados dois grupos: o primeiro recebeu pequenas doses de petidina (0,25 mg/kg) e o segundo grupo recebeu doses habituais de dipi-rona sódica (25 mg/kg) durante a fase ativa do trabalho de parto, estando o colo uterino dila-tado em, pelo menos, 5 centímetros. As medicações da pesquisa foram administradas uma única vez e por via endovenosa. As 200 parturientes da pesquisa apresentavam dores intensas. A dor foi avaliada pela escala visual analógica em três momentos distintos: antes, uma hora e duas horas após a administração dos analgésicos. A expectativa era que um dos fármacos fos-se superior ao outro. A análise dos resultados evidenciou que os dois fármacos têm potências equivalentes durante o trabalho de parto, no qual a ação analgésica só ocorreu durante a pri-meira hora após a intervenção. Não houve diferenças quanto aos efeitos adversos. PALAVRAS-CHAVE: Analgesia; Parto humanizado.

Up to 65% of individuals with a spinal cord injury (SCI) experience neuropathic pain, and cite this as one of the most significant consequences of injury. Opiate analgesics are one of the most effective, but also most concerning, treatments for neuropathic pain. In fact, the use of morphine after SCI can potentiate the development of paradoxical pain symptoms, and continuous administration can lead to dependence, tolerance, and addiction. Empirical evidence suggests that the addictive potential of morphine decreases when used to treat neuropathic pain, but this has not been studied in an SCI model. These studies, therefore, aimed to investigate the addictive potential of morphine in a rodent model of spinal contusion injury. These experiments used a conditioned place preference (CPP) paradigm to examine whether subjects with SCI would develop a preference in the acute phase of injury, and whether a place preference would be expressed after the development of neuropathic pain symptoms in the chronic phase of injury. Results suggest that the time of treatment did affect the development of a preference for the morphine-paired context; subjects displayed a CPP in the acute, but not the chronic phase of SCI. In addition, the findings indicate that spinal neurons are sufficient, but not necessary, for producing a morphine-induced place preference. Overall, the results suggest that morphine could be used for the clinical treatment of neuropathic pain without concerns of addiction. Although SCI alone did not reduce the addictive potential of morphine in the acute phase of injury, the lack of preference in the chronic phase suggests that addiction may be reduced by molecular changes that accompany the development of neuropathic pain. Moreover, we hypothesize that the analgesic effects of morphine acting on spinal and peripheral mu-opioid receptors (MOR's) underlies the development of CPP in the acute phase of injury. This hypothesis is supported by the CPP established with intrathecal morphine administration. Nonetheless, the current studies cannot discount the role of supraspinally-mediated reward in the development of place preference after injury. Further work is needed to distinguish between the addictive and analgesic properties of morphine.

Objetivo: Determinar la eficacia analgésica y sedativa de la dexmedetomidina así como la seguridad de la administración de la misma en pacientes postoperados Metodología: Se diseño un estudio descriptivo, serie de casos, longitudinal, prospectivo a simple ciego, la muestra incluyo 25 pacientes (relacionado al costo de la droga y la dificultad para su obtención) que cumplieron con los criterios de inclusión: a.- Edad: 18 a 65 años. b.- Pacientes ASA I – II c.- Pacientes sometidos a anestesia general operados de colecistectomía laparoscópica d.- Pacientes que no presenten alergia conocida a cualquiera de los medicamentos usados dentro del protocolo del estudio Un observador vigilo el cumplimiento del protocolo intraoperatorio y otro monitorizo y registro los valores relacionados a cambios hemodinámicos y ventilatorios, así como los valores de EVA para el dolor y Ramsay para sedación en la Unidad de Recuperación post-Anestésica. Los datos obtenidos fueron ingresados a una hoja de cálculo en Excel y procesados y analizados con el programa SPSS Resultados: Un 92% de los pacientes estaban comprendidos entre los 40 y 65 años, la mitad de ellos comprendidos en cada sexo 52% masculino y 48% femenino. En relación a la eficacia analgésica se observó una disminución progresiva de los valores de EVA a medida que se desarrollaba la infusión, sin embargo un 40% de los pacientes fue necesario un complemento analgésico con opioide para alcanzar el objetivo analgésico (EVA menor de 4). En relación a la eficacia sedativa se observó una progresiva profundidad en los niveles de sedación destacándose sin embargo la cualidad de “sedación activa” descrita para la droga. En relación a la seguridad de la administración se evidencian cambios predecibles de la frecuencia cardiaca: bradicardia en un 80% de los pacientes, que responden fácilmente a la administración de atropina. Se observó además hipotensión en 20% de los casos, no siendo necesario en ningún caso el uso de vasopresores. No se evidencia depresión ventilatoria en ningún caso. Conclusiones: La infusión de dexmedetomidina por sí misma no evidencia ser suficiente para aliviar el dolor de los pacientes sometidos al estudio probablemente disminuya los requerimientos de analgésicos opioides. La eficacia sedativa ha sido demostrada. Así mismo se demuestra que la droga es segura con la dosis administrada en el presente estudio.

published_or_final_version / Public Health / Master / Master of Public Health