Orientadores: Francisco Carlos Groppo, Eneida de Paula / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T23:31:57Z (GMT). No. of bitstreams: 1 Franz-Montan_Michelle_M.pdf: 573727 bytes, checksum: adca86b59035ee8f175fca2d22f1e4f6 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo cruzado e cego foi avaliar a eficácia da anestesia tópica de ropivacaína a 1% (forma lipossomada ou não) em Odontologia. Trinta voluntários foram submetidos à anestesia tópica com quatro anestésicos, em oito sessões (tratamentos) determinadas aleatoriamente: 20mg de gel de ropivacaína a 1% -Ropi-20, 60mg de gel de ropivacaína a 1% -Ropi-60, 20mg de gel de ropivacaína a 1% encapsulada em lipossomas -RopiLipo-20, 60mg de gel de ropivacaína a 1% encapsulada em lipossomas -RopiLipo-60, 20mg da mistura eutética de lidocaína a 2.5% e prilocaína a 2.5% (EMLA cream AstraZeneca®) - EMLA-20, 60mg de EMLA cream -EMLA-60, 20mg de gel de benzocaína a 20% (Benzotop® DFL) -Benzo-20 e 60mg de gel de benzocaína a 20% -Benzo-60. Cada tratamento foi aplicado no fundo de sulco da região de canino superior direito durante dois minutos; o intervalo entre os tratamentos foi de uma semana. Foram avaliadas a anestesia pulpar, por meio de estímulo elétrico (pulp tester); a dor durante a punção por meio das escalas analógica visual (EAV) e de 11 pontos em caixa (E11); e a anestesia em tecido mole por meio de estímulo físico. A influência do anestésico na resposta pulpar foi avaliada durante 20 minutos após a aplicação do anestésico tópico. Não houve diferença estatisticamente significante entre os tratamentos com relação às escalas EAV e E11 (p>0.05). A duração da anestesia em tecido mole com o EMLA-60 e RopiLipo-60 foi maior (p<0.05) do que com os outros tratamentos. No entanto, entre EMLA-60 e RopiLipo-60 não houve diferença estatisticamente significante (p>0.05). Nenhum dos tratamentos avaliados exerceu efeito anestésico sobre o tecido pulpar. Assim, a ropivacaína a 1% encapsulada ou não em lipossomas apresentaram eficácia semelhante em reduzir a dor à punção em comparação aos outros anestésicos avaliados, no entanto, nas condições avaliadas, nenhum dos anestésicos exerceu influência sobre a resposta pulpar / Abstract: The objective of this blind and crossover study was to evaluate the efficacy of 1% ropivacaine (liposomal and nonliposomal) for topical anesthesia in Dentistry. Thirty healthy volunteers randomly received the following treatments in eight sessions: 20mg of 1% ropivacaine -Ropi-20, 60mg of 1% ropivacaine -Ropi-60, 20mg of liposome encapsulated 1% ropivacaine -RopiLipo-20, 60mg of liposome encapsulated 1% ropivacaine -RopiLipo-60, 20mg of the eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA cream AstraZeneca®) -EMLA-20, 60mg of EMLA cream -EMLA-60, 20mg of 20% benzocaine gel (Benzotop® DFL) -Benzo-20 and 60mg of 20% benzocaine gel -Benzo-60. At different sessions each treatment was applied in the maxillary-buccal fold of the right canine for two minutes; one week of interval between treatments. Pulpal anesthesia was evaluated using an electrical pulp tester; pain during needle insertion by using a visual analogue scale (VAS) and 11-point box scale (BS-11) and soft tissue anesthesia by using a pinprick test. The influence on pulpal response was assessed for 20 minutes after topical application. There were no statistically significant differences among treatments considering VAS and BS-11 scores (p=0.177 and p=0.179, respectively). RopiLipo-60 and EMLA-60 provided a statistically significant longer duration of topical anesthesia than the other topical agents (p<0.05), however, RopiLipo-60 was not significantly different from EMLA-60 (p>0.05). There was no influence on the pulpal response provided by the topical anesthetics evaluated. Liposome and nonliposomal ropivacaine gel at 1% concentration showed similar efficacy for topical anesthesia in oral mucosa when compared to the other topical anesthetics. However, none of the topical anesthetics evaluated were effective in inducing pulpal anesthesia under the evaluated conditions / Mestrado / Farmacologia, Anestesiologia e Terapeutica / Mestre em Odontologia

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Bupivacaine ((R, S)-1-butyl-2-piperidylformo-2', 6'-xylidide), an anilide type local anaesthetic is manufactured in the standard racemic form and is widely used in the practice of regional anaesthesia. Despite its popularity as a local anesthetic, it has the potential to produce severe cardiotoxicity. Enantiomers, which are a pair of chiral isomers that are direct, nonsuperimposable mirror images of each other, vary in their chemical, pharmacological and toxicological profiles due to different stereospecific recognition in the body. Single enantiomeric drugs, when compared to racemic drugs, exert similar clinical effects but produce decreased risks of cardiac and neurotoxicity. This has led to the development of the single enantiomeric drugs ropivacaine ((S)-1-propyl-2-piperidylformo-2', 6'-xylidide) and levobupivacaine ((S)-1-butyl-2-piperidylformo-2', 6'-xylidide). Since local anaesthetics are extensively bound (>90%) to plasma protein in blood such as album and alpha1-acid-glycoprotein, it is only the free form of the flowing drug that can exert its pharmacological effects and are believed to be closely related to systemic toxicity. Although the safety and efficacy of these newer local anaesthetics have been ascertained in the literatures, but there are limited data on their pharmacokinetic profiles; thus it is envisioned that further pharmacokinetic trials would be required to elucidate their pharmacological and clinical effects. The aim of this thesis was to develop sensitive, reproducible and reliable methods of local anaesthetic assays to support such clinical trials. / The assays described in the thesis have been applied to numerous clinical research projects. Out of the various studies, the following will be discussed: Ropivacaine undergoes slower systemic absorption from the caudal epidural space in children than bupivacaine; Arterial and venous pharmacokinetics of ropivacaine with and without epinephrine after thoracic paravertebral block; Pharmacokinetics of levobupivacaine after thoracic paravertebral block. / The first method developed is the simultaneous determination of ropivacaine and bupivacaine in human plasma using high performance chromatography (HPLC). Most published methods of determining ropivacaine in human plasma use gas chromatography and a review of literature to date shows no data describing the use of HPLC to simultaneously determine both drugs. This is the first report describing a simple, isocratic, reversed-phase, liquid-liquid extraction procedure of high-performance liquid chromatographic method that allows the simultaneous detection of both local anaesthetics in one single injection. The chromatography was achieved using a reversed-phase chromatographic system with a Waters Novapak C18 column. 0.5 ml plasma was used for the sample preparation procedures. Bupivacaine and ropivacaine concentrations ranging from 10ng/ml to 3000 ng/ml and fixed amounts of pentycaine (internal standard) were spiked into the plasma samples for calculating the calibration graphs. Calibration graphs were linear over the range 10-3000 ng/ml (r=0.9978 for bupivacaine and r=0.9986 for ropivacaine). The within-day (intra-assay) coefficient of variation of the assay varied between 13.84% at 100 ng/ml, 1.84% at 500 ng/ml and 3.34% at 2000 ng/ml for bupivacaine; and 5.29% at 100 ng/ml, 1.38% at 500 ng/ml and 3.93% at 2000 ng/ml for ropivacaine. The between-day (inter-assay) coefficient of variation was 8.43% at 100 ng/ml, 4.06% at 500 ng/ml and 9.15% at 2000 ng/ml for bupivacaine, and 5.66% at 100 ng/ml, 4.40% at 500 ng/ml and 8.14% at 2000 ng/ml for ropivacaine. The limit of detection for both drugs was 10 ng/ml. / The fourth analytical technique describes the successful development of an ultrafiltration protein binding procedure to detect the free levels of the local anaesthetics in human plasma. Sample plasma was deposited in the ultrafiltration apparatus and ultrafiltrate containing the free local anaesthetics was forced thru a membrane under a fixed-angle rotor centrifugal force. Experiments were done to establish the optimum parameters for the ultrafiltration apparatus' binding capacities. The validated procedures use 0.5 ml plasma as the starting volume and it was deposited into the ultrafiltration apparatus. It was then subjected to 1750g centrifugal force for 20 minutes at centrifugal temperature of 37&deg;C. The resultant ultrafiltrate was processed according to the described LC-MS/MS method to detect the free local anaesthetic levels. / The second analytical methodology describes the assay of levobupivacaine in human plasma using HPLC. Calibration graphs relating peak height ratios and concentrations were linear over the range 10-3000 ng/ml (r=0.9995). The chromatography was achieved with an XTerra MS C18 column with the ultraviolet monitor set at 210 nm. The sample preparation steps were similar to the first analytical method, but with a different internal standard used. Precision and accuracy were assessed by performing analysis on replicate control plasma samples. The within-day (intra-assay) coefficient of variation of the assay varied between 4.25% at 50 ng/ml, 3.38% at 500 ng/ml, 3.76% at 1000 ng/ml and 3.14% at 2000 ng/ml. The between-day (inter-assay) coefficient of variation of the assay varied between 4.68% at 50 ng/ml, 4.94% at 500 ng/ml, 4.25% at 1000 ng/ml and 2.94% at 2000 ng/ml. The limit of detection was 10 ng/ml. / The third analytical methodology details the development and validation of a chiral analytical technique. This is the first report describing the development of a simple, isocratic, reversed-phase, liquid-liquid extraction procedure of a direct chiral method that allows the simultaneous detection of either free or total concentrations of bupivacaine enantiomers and ropivacaine in one single injection. It is also a novel technique to assay bupivacaine enantiomers with the use of vancomycin CSP column and liquid chromatography-mass spectrometry (LC-MS/MS) analysis, which achieved the lowest published detection limit with the lowest volume of plasma used. Calibration graphs were linear over the range 0.1-2000 ng/ml. Precision and accuracy were assessed by performing analysis on replicate control plasma samples. The within-day (intrassay) coefficient of variations of the assay for the drugs ropivacaine, levobupivacaine, dextrobupivacaine varied from 2.20% to 5.78%, 1.96% to 9.64%, 1.78% to 6.34%, respectively, for concentrations between 0.5 ng/ml to 2000 ng/ml. The between-day (interassay) coefficient of variations of the assay for the drugs ropivaciane, levobupivacaine, dextrobupivacaine varied from 3.66% to 9.61%, 3.18% to 8.34%, 2.22% to 10.59%, respectively, for concentrations between 0.5 ng/ml to 2000 ng/ml. The limit of detection was 0.05 ng/ml. / Wong Sum Yee April. / "November 2005." / Advisers: Manoj Karmakar; Tony Gin. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6370. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 207-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 6 uppsatser.

A dor pélvica crônica é uma condição de grande impacto na saúde da população feminina, em termos de qualidade de vida e uso de recursos em saúde. Dentre os diferentes tratamentos, encontramos terapias hormonais, cirurgia e uso de medicamentos neuromoduladores da dor. Sabe-se que a dor crônica provoca sensibilização nervosa periférica, com achados ao exame físico como linfotrofoedema e hiperalgesia. O bloqueio anestésico paraespinhoso é utilizado para o tratamento da sensibilização periférica em desordens de origem osteomuscular, com base no princípio da sensibilização do dermátomo e do miótomo. Poucos estudos, no entanto, tratam sobre o uso desse mesmo procedimento para o tratamento da dor do viscerótomo. No presente estudo, foram randomizadas 17 pacientes com dor pélvica crônica entre os tratamentos intervenção (bloqueio anestésico paraespinhoso) e placebo (punção subcutânea sem efeito analgésico). A dor foi mensurada através da escala análogo-verbal (EAV). A redução da dor imediatamente após o procedimento foi significativa nas pacientes do grupo intervenção (p=0,03), não havendo redução significativa no grupo controle. O efeito não se manteve em uma semana após o procedimento. Os resultados sugerem que o bloqueio paraespinhoso é eficaz no tratamento da dor pélvica crônica em curto prazo. / Objective: To evaluate whether paraspinous block reduces the verbal analog scale (VAS) pain scores in patients with chronic pelvic pain (CPP) refractory to drug therapy. Design: Randomized, double-blind, superiority trial. Setting: Tertiary referral center. Participants: Thirty-eight community patients were selected. Patients' mean age was 51.16 years (intervention) and 51.84 years (control). Patients eligible for the study had a diagnosis of CPP of benign etiology and refractory to drug therapy. Twenty-six patients were randomized to the intervention and control groups. Twelve patients were excluded before randomization because they refused to participate, did not meet the inclusion criteria, or withdrew from the study. Interventions: Patients in the intervention group received paraspinous anesthetic block. After finding the painful segment, paraspinous block was injected along the spinous process and in the supraspinous and interspinous ligaments, using a 25G X 2" needle and 1% lidocaine without epinephrine. Main outcome measure: The variation in the verbal analog scale (VAS) pain scores between T0 and T2. Results: A blinded examiner measured the degree of pain according to the VAS from 0 (no pain) to 10 (worst pain imaginable). Based on the VAS, the mean pain scores (standard deviation; 95%CI) of the intervention group at T0 (baseline), T1 (immediately after the procedure), and T2 (one week after the procedure) were 5.50 (2.92; 3.84-7.15), 2.72 (2.10; 1.53-3.90), and 4.36 (2.37; 1.89-6.82), respectively. The difference between T0 and T1 was statistically significant, with a p-value = 0.03 (Table 2). Conclusions: The present study assessed patients with CPP, excluding visceral pain of other etiologies. Therefore, further studies are needed to evaluate the efficacy of paraspinous anesthetic block in the treatment of visceral pain of other causes.

Made available in DSpace on 2014-06-11T19:25:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-08-24Bitstream added on 2014-06-13T19:12:40Z : No. of bitstreams: 1 canoa_jtb_me_araca.pdf: 7064516 bytes, checksum: 9ec9f5c1485210ad8d9d967a430df0f7 (MD5) / O presente estudo teve como objetivos avaliar os efeitos paramétricos, analgésico, sedativo e a dose mais adequada de midazolam (50 ou 100μg/kg) associado à ropivacaína pela via peridural em cadelas submetidas à OSH eletiva. Participaram do estudo, 24 cadelas sadias, adultas, de diferentes raças, com peso médio de 8,25 kg, as quais foram pré-medicadas com acepromazina (0,05mg/kg, IM), seguindo-se a indução e a manutenção anestésica com propofol (5 mg/kg) e isofluorano, respectivamente, sendo alocadas em três grupos experimentais: GR - ropivacaína 0,2 mL/kg, GM100 - midazolam (100μg/kg) + ropivacaína 0,2mL/kg e GM50 - midazolam (50μg/kg) + ropivacaína 0,2mL/kg. Foram avaliados: frequências cardíaca e respiratória, pressão arterial sistólica, temperatura retal, saturação de oxigênio na hemoglobina, variáveis hemogasométricas, concentração plasmática de cortisol, grau de analgesia pós-operatória e sedação. Os dados foram submetidos à ANOVA, seguidas pelo teste Tukey no programa SAS (p<0.05). Para as variáveis qualitativas ordinais foram realizados os testes Kruskal- Wallis, teste de Friedman e o teste de Dunn. Foram observados efeitos analgésicos mais duradouros do anestésico local no grupo dos animais em que se utilizou a dose de 100μg/kg de midazolam, quando comparados ao grupo que utilizou 50μg/kg e 50% dos animais do grupo GM100 receberam analgesia resgate 12 horas após a cirurgia. A associação do midazolam na dose de 100μg/kg à ropivacaína apresentou efeito superior à dose de 50μg/kg de midazolam, que não potencializou o efeito analgésico, porém, prolongou o período de analgesia residual pós-operatório. Concluiu-se que a associação do midazolam à ropivacaína não produziu alterações paramétricas significativas, nem efeitos adicionais sobre a sedação, entretanto o midazolam na dose de 100μg/kg pode ser pode ser mais... / This research aimed evaluate the parametric, analgesic, sedative effects and most appropriate dose of midazolam (50 or 100μg.kg) for epidural anesthesia bitches submitted the elective ovariosalpingohisterectomy. Twenty-four bitches tool part study, adults, different breeds, mediun weigh 8.25 kg and premedicated with acepromazine (0.05 mg.kg, IM), followed by anesthetic induction and maintenance with propofol (5mg.kg) and isoflurane, respectively, and allocated in three experimental groups: GR - ropivacaine 0.2 mL.kg, GM50 - midazolam (50μg.kg) + ropivacaine 0.2 mL.kg and GM100 - midazolam (100μg.kg) + ropivacaine 0.2 mL.kg. Were evaluated: heart and respiratory rate, indirect systolic arterial pressure, rectal temperature, oxygen saturation in hemoglobin, blood gas variables, plasma cortisol, degree of postoperative analgesia and sedation. The results was submitted to ANOVA followed by Tukey test in the SAS (p <0.05). From the qualitative variables were performed ordinal tests Kruskal-Wallis, Friedman and Dunn tests. Were observed effects more durable local anesthetic in the group of animals that used the 100μg/kg dose of midazolam as compared to the group that used 50μg.kg and 50% of the animals tested GM100 received rescue analgesia 12 hours after surgery. The combination of midazolam in the dose of ropivacaine had 100μg/kg the upper end of the dose of midazolam 50μg.kg, not increasing the analgesic effect, however, extending the period of residual postoperative analgesia. It was concluded that the association of midazolam to ropivacaine did not produce significant parametric changes or additional sedation effects, but midazolam in 100μg.kg may be another option in releave post-operative pain on OSH bitches surgery (procedure) in bitches subjected the OSH.

Resumo: O presente estudo teve como objetivos avaliar os efeitos paramétricos, analgésico, sedativo e a dose mais adequada de midazolam (50 ou 100μg/kg) associado à ropivacaína pela via peridural em cadelas submetidas à OSH eletiva. Participaram do estudo, 24 cadelas sadias, adultas, de diferentes raças, com peso médio de 8,25 kg, as quais foram pré-medicadas com acepromazina (0,05mg/kg, IM), seguindo-se a indução e a manutenção anestésica com propofol (5 mg/kg) e isofluorano, respectivamente, sendo alocadas em três grupos experimentais: GR - ropivacaína 0,2 mL/kg, GM100 - midazolam (100μg/kg) + ropivacaína 0,2mL/kg e GM50 - midazolam (50μg/kg) + ropivacaína 0,2mL/kg. Foram avaliados: frequências cardíaca e respiratória, pressão arterial sistólica, temperatura retal, saturação de oxigênio na hemoglobina, variáveis hemogasométricas, concentração plasmática de cortisol, grau de analgesia pós-operatória e sedação. Os dados foram submetidos à ANOVA, seguidas pelo teste Tukey no programa SAS (p<0.05). Para as variáveis qualitativas ordinais foram realizados os testes Kruskal- Wallis, teste de Friedman e o teste de Dunn. Foram observados efeitos analgésicos mais duradouros do anestésico local no grupo dos animais em que se utilizou a dose de 100μg/kg de midazolam, quando comparados ao grupo que utilizou 50μg/kg e 50% dos animais do grupo GM100 receberam analgesia resgate 12 horas após a cirurgia. A associação do midazolam na dose de 100μg/kg à ropivacaína apresentou efeito superior à dose de 50μg/kg de midazolam, que não potencializou o efeito analgésico, porém, prolongou o período de analgesia residual pós-operatório. Concluiu-se que a associação do midazolam à ropivacaína não produziu alterações paramétricas significativas, nem efeitos adicionais sobre a sedação, entretanto o midazolam na dose de 100μg/kg pode ser pode ser mais... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This research aimed evaluate the parametric, analgesic, sedative effects and most appropriate dose of midazolam (50 or 100μg.kg) for epidural anesthesia bitches submitted the elective ovariosalpingohisterectomy. Twenty-four bitches tool part study, adults, different breeds, mediun weigh 8.25 kg and premedicated with acepromazine (0.05 mg.kg, IM), followed by anesthetic induction and maintenance with propofol (5mg.kg) and isoflurane, respectively, and allocated in three experimental groups: GR - ropivacaine 0.2 mL.kg, GM50 - midazolam (50μg.kg) + ropivacaine 0.2 mL.kg and GM100 - midazolam (100μg.kg) + ropivacaine 0.2 mL.kg. Were evaluated: heart and respiratory rate, indirect systolic arterial pressure, rectal temperature, oxygen saturation in hemoglobin, blood gas variables, plasma cortisol, degree of postoperative analgesia and sedation. The results was submitted to ANOVA followed by Tukey test in the SAS (p <0.05). From the qualitative variables were performed ordinal tests Kruskal-Wallis, Friedman and Dunn tests. Were observed effects more durable local anesthetic in the group of animals that used the 100μg/kg dose of midazolam as compared to the group that used 50μg.kg and 50% of the animals tested GM100 received rescue analgesia 12 hours after surgery. The combination of midazolam in the dose of ropivacaine had 100μg/kg the upper end of the dose of midazolam 50μg.kg, not increasing the analgesic effect, however, extending the period of residual postoperative analgesia. It was concluded that the association of midazolam to ropivacaine did not produce significant parametric changes or additional sedation effects, but midazolam in 100μg.kg may be another option in releave post-operative pain on OSH bitches surgery (procedure) in bitches subjected the OSH. / Orientador: Valéria Nobre Leal de Souza Oliva / Coorientador: Renata Navarro Cassu / Banca: Lídia Mitsuko Matsubara / Banca: Paulo Sérgio Patto dos Santos / Mestre

A dor pélvica crônica é uma condição de grande impacto na saúde da população feminina, em termos de qualidade de vida e uso de recursos em saúde. Dentre os diferentes tratamentos, encontramos terapias hormonais, cirurgia e uso de medicamentos neuromoduladores da dor. Sabe-se que a dor crônica provoca sensibilização nervosa periférica, com achados ao exame físico como linfotrofoedema e hiperalgesia. O bloqueio anestésico paraespinhoso é utilizado para o tratamento da sensibilização periférica em desordens de origem osteomuscular, com base no princípio da sensibilização do dermátomo e do miótomo. Poucos estudos, no entanto, tratam sobre o uso desse mesmo procedimento para o tratamento da dor do viscerótomo. No presente estudo, foram randomizadas 17 pacientes com dor pélvica crônica entre os tratamentos intervenção (bloqueio anestésico paraespinhoso) e placebo (punção subcutânea sem efeito analgésico). A dor foi mensurada através da escala análogo-verbal (EAV). A redução da dor imediatamente após o procedimento foi significativa nas pacientes do grupo intervenção (p=0,03), não havendo redução significativa no grupo controle. O efeito não se manteve em uma semana após o procedimento. Os resultados sugerem que o bloqueio paraespinhoso é eficaz no tratamento da dor pélvica crônica em curto prazo. / Objective: To evaluate whether paraspinous block reduces the verbal analog scale (VAS) pain scores in patients with chronic pelvic pain (CPP) refractory to drug therapy. Design: Randomized, double-blind, superiority trial. Setting: Tertiary referral center. Participants: Thirty-eight community patients were selected. Patients' mean age was 51.16 years (intervention) and 51.84 years (control). Patients eligible for the study had a diagnosis of CPP of benign etiology and refractory to drug therapy. Twenty-six patients were randomized to the intervention and control groups. Twelve patients were excluded before randomization because they refused to participate, did not meet the inclusion criteria, or withdrew from the study. Interventions: Patients in the intervention group received paraspinous anesthetic block. After finding the painful segment, paraspinous block was injected along the spinous process and in the supraspinous and interspinous ligaments, using a 25G X 2" needle and 1% lidocaine without epinephrine. Main outcome measure: The variation in the verbal analog scale (VAS) pain scores between T0 and T2. Results: A blinded examiner measured the degree of pain according to the VAS from 0 (no pain) to 10 (worst pain imaginable). Based on the VAS, the mean pain scores (standard deviation; 95%CI) of the intervention group at T0 (baseline), T1 (immediately after the procedure), and T2 (one week after the procedure) were 5.50 (2.92; 3.84-7.15), 2.72 (2.10; 1.53-3.90), and 4.36 (2.37; 1.89-6.82), respectively. The difference between T0 and T1 was statistically significant, with a p-value = 0.03 (Table 2). Conclusions: The present study assessed patients with CPP, excluding visceral pain of other etiologies. Therefore, further studies are needed to evaluate the efficacy of paraspinous anesthetic block in the treatment of visceral pain of other causes.

A dor pélvica crônica é uma condição de grande impacto na saúde da população feminina, em termos de qualidade de vida e uso de recursos em saúde. Dentre os diferentes tratamentos, encontramos terapias hormonais, cirurgia e uso de medicamentos neuromoduladores da dor. Sabe-se que a dor crônica provoca sensibilização nervosa periférica, com achados ao exame físico como linfotrofoedema e hiperalgesia. O bloqueio anestésico paraespinhoso é utilizado para o tratamento da sensibilização periférica em desordens de origem osteomuscular, com base no princípio da sensibilização do dermátomo e do miótomo. Poucos estudos, no entanto, tratam sobre o uso desse mesmo procedimento para o tratamento da dor do viscerótomo. No presente estudo, foram randomizadas 17 pacientes com dor pélvica crônica entre os tratamentos intervenção (bloqueio anestésico paraespinhoso) e placebo (punção subcutânea sem efeito analgésico). A dor foi mensurada através da escala análogo-verbal (EAV). A redução da dor imediatamente após o procedimento foi significativa nas pacientes do grupo intervenção (p=0,03), não havendo redução significativa no grupo controle. O efeito não se manteve em uma semana após o procedimento. Os resultados sugerem que o bloqueio paraespinhoso é eficaz no tratamento da dor pélvica crônica em curto prazo. / Objective: To evaluate whether paraspinous block reduces the verbal analog scale (VAS) pain scores in patients with chronic pelvic pain (CPP) refractory to drug therapy. Design: Randomized, double-blind, superiority trial. Setting: Tertiary referral center. Participants: Thirty-eight community patients were selected. Patients' mean age was 51.16 years (intervention) and 51.84 years (control). Patients eligible for the study had a diagnosis of CPP of benign etiology and refractory to drug therapy. Twenty-six patients were randomized to the intervention and control groups. Twelve patients were excluded before randomization because they refused to participate, did not meet the inclusion criteria, or withdrew from the study. Interventions: Patients in the intervention group received paraspinous anesthetic block. After finding the painful segment, paraspinous block was injected along the spinous process and in the supraspinous and interspinous ligaments, using a 25G X 2" needle and 1% lidocaine without epinephrine. Main outcome measure: The variation in the verbal analog scale (VAS) pain scores between T0 and T2. Results: A blinded examiner measured the degree of pain according to the VAS from 0 (no pain) to 10 (worst pain imaginable). Based on the VAS, the mean pain scores (standard deviation; 95%CI) of the intervention group at T0 (baseline), T1 (immediately after the procedure), and T2 (one week after the procedure) were 5.50 (2.92; 3.84-7.15), 2.72 (2.10; 1.53-3.90), and 4.36 (2.37; 1.89-6.82), respectively. The difference between T0 and T1 was statistically significant, with a p-value = 0.03 (Table 2). Conclusions: The present study assessed patients with CPP, excluding visceral pain of other etiologies. Therefore, further studies are needed to evaluate the efficacy of paraspinous anesthetic block in the treatment of visceral pain of other causes.