Made available in DSpace on 2014-06-11T19:32:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-29Bitstream added on 2014-06-13T19:43:48Z : No. of bitstreams: 1 steagall_pvm_dr_botfm.pdf: 393562 bytes, checksum: 5728f72f985284dda5f8f079a19a7e0a (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do estudo foi avaliar os efeitos antinociceptivos da buprenorfina em gatos, quando administrada em diferentes doses pela via intravenosa (IV), e também por diferentes vias de administração, por meio da mensuração do limiar nociceptivo térmico (LNT) e mecânico (LNM) num estudo cruzado, cego e aleatório. O estímulo nociceptivo térmico (LNT) foi realizado por meio de um dispositivo justaposto a um mangüito de pressão neonatal, posicionado ao redor do tórax do gato por uma cinta elástica. O estímulo nociceptivo mecânico foi realizado por meio de um bracelete de plástico, colocado ao redor do antebraço do gato. Na primeira fase, após as mensurações basais dos LNT e LNM, oito gatos (3,8±0,6kg) receberam buprenorfina (IV) nas doses de 0,01 (B1), 0,02 (B2) e 0,04 (B4) mg/kg. As mensurações foram feitas até 10h após cada tratamento. Na segunda fase, após as mensurações basais dos LNT, seis gatos (4,1±0,5kg) receberam buprenorfina (0,02 mg/kg) pelas vias IV, intramuscular (IM) e subcutânea (SC). As mensurações foram realizadas até 24h após cada tratamento. Na terceira fase, após as mensurações basais dos LNT e LNM, oito gatos (4,7±1,5kg) receberam buprenorfina (0,02 mg/kg) pela via epidural, por meio de uma via de acesso vascular implantada cirurgicamente antes do início do estudo. As mensurações foram realizadas até 24h após cada tratamento. Os dados foram analisados por ANOVA (P<0,05). Os LNT e LNM acima do intervalo de confiança de 95% (IC95%), gerados pelos valores basais, indicaram antinocicepção. Na primeira fase, os LNT e os LNM aumentaram significativamente entre 15min e 4h (LNT) após B1, entre 15min e 2h e aos 15 e 45min após B2, e entre 15min e 8h, exceto às 4h, e entre 30min e 2h, após B4, respectivamente. Aos 45min, os LNM foram significativamente maiores em B2 quando comparados a B1. As médias dos LNT e dos LNM ficaram... / The aim of this study was to evaluate the antinociceptive effects of buprenorphine in cats after intravenous (IV) administration of different doses and after different routes of administration, by means of measuring thermal (TT) and mechanical (MT) nociceptive thresholds, in a randomized, blinded and crossover study. Thermal stimulation was given via a probe, attached to an elasticated band and positioned around the cat’s thorax with an inflated modified neonatal cuff. Mechanical stimulation was given via a plastic bracelet with a modified neonatal cuff, taped around the cat’s antebrachium. In the first phase, after MT and TT baseline recordings, eight cats (3.8±0.6kg) were given 0.01 (B1), 0.02 (B2) and 0.04 (B4) mg/kg of buprenorphine IV. Thresholds were measured until 10h after administration of treatments. In the second phase, after TT baseline recordings, buprenorphine (0.02 mg/kg) was administered to six cats (4.1±0.5kg) by the IV, intramuscular (IM) and subcutaneous (SC) routes. Threshold measurements were performed up to 24h after treatments. In the third phase, after TT and MT baseline recordings, eight cats (4.7±1.5kg) received buprenorphine (0.02 mg/kg), through a vascular access port that had been surgically implanted in the epidural space. TT and MT were measured up to 24h after each treatment. Data were analyzed by ANOVA (P<0.05). A 95% confidence interval (IC95%) was generated by the baseline values. Thresholds above IC95% indicated antinociception. In the first phase, compared to baseline, TT were significantly increased between 15min and 4h after B1, between 15min and 2h after B2, and between 15min and 8h, expect at 4h, after B4. MT was significantly increased at 15 and 45min after B2 and between 30min and 2h after B4. At 45min, MT were significantly higher in B2 compared to B1. Mean TT were above the IC95% from 15min to 10h in all groups. Mean MT were... (Complete abstract click electronic access below)

Bakgrund: Heroin är en opiat ursprungen från opiumvallmon och är starkt förknippad med beroende och död. När heroin och andra kortverkande opiater binder in till μ-opioidreceptorer i hjärnan sker en ökad frisättning av signalsubstansen dopamin och en stark känsla av eufori infinner sig. Vid upprepat intag sker förändringar i hjärnan; belöningseffekten minskar medan antibelöningseffekterna ökar och cravings och abstinensymptom blir allt tydligare vid frånvaro av drogen. Vid läkemedelsassisterad rehabilitering vid opiatberoende (LARO) används förutom psykosocial behandling även långverkande opioider såsom opioidagonisten metadon och den partiella opioidagonisten buprenorfin, för att återställa homeostasen och reducera cravings och abstinenssymptom som opioidberoendet har skapat. Metadon är effektivt vid beroendebehandling men dess risker begränsar dess användning. Buprenorfin har lägre överdospotential men eventuellt sämre effekt än metadon. Syfte: Syftet med denna litteraturstudie var att undersöka skillnad i effekt mellan buprenorfinpreparat och metadon vid behandling av opioidberoende. Metod: Arbetet är en litteraturstudie baserat på fem vetenskapliga studier vilka har erhållits via sökning i PubMed samt Cochrane Library. De aspekter som avhandlats är; fullföljande och retention av behandling, samtidigt sidomissbruk av opiater samt allvarliga incidenter och biverkningar. Resultat: De inkluderade studierna i denna litteraturstudie visade att metadon är bättre på att bevara patienter i behandling medan buprenorfin mer effektivt kan minska sidomissbruket av opiater. Ju högre doser som användes, desto fler deltagare stannade kvar i behandling och desto färre urinprover rapporterades positiva för sidomissbruk av opiater. Få allvarliga incidenter rapporterades från studierna. Slutsats: Både metadon och buprenorfinpreparaten har sina för- och nackdelar.  Då behandling med metadon tidigare bevisats vara mer riskfyllt bör buprenorfinpreparaten utgöra förstahandsval, men vid otillräcklig effekt bör byte till metadon ske. Detta överrensstämmer med riktlinjerna i Sverige idag. Dock tycks det finnas anledning att i framtida studier undersöka dos-effekt-samband för både dessa preparat, samt också att fokusera på den initiala fasen vid behandling med buprenorfin. / Background: Heroin is an opiate from the opium poppy which is strongly associated with dependence, overdose and death. When heroin and other opiates binds to the μ-opioid receptors located in the brain, dopamine is released from the ventral tegmental area and a strong feeling of euphoria arises. Continuous intake of opioids cause changes in the brain and the feeling of euphoria will be less distinct during drug intake. Instead, cravings and abstinence, will be more distinctive in absence of the drug and causes drug-abusers to continue to use the drug. The cravings and abstinence is due to an overactive HPA-axis and amygdala. This overactivity can be reduced by treatment with long lasting opioids that is used in treatment of opioid dependence. The development of opioid maintenance treatment started in the US during the early 1960s. A few years later, opioid dependent people could join the first opioid maintenance treatment program in Uppsala, Sweden. The opioid maintenance treatment involves both pharmacological and psychosocial treatment. There are two main substances available for opioid maintenance treatment in Sweden: methadone, a full μ-opioid receptor agonist and buprenorphine, a partial μ-opioid receptor agonist. Methadone has been proven to be very efficacious treating opioid dependence. However, the risk of overdose leading to respiratory depression, limits its usefulness. Buprenorphine on the other hand, has a lower risk of toxicity but may not have same efficacy as methadone. Aim: The purpose of this literature study is to examine the efficacy of buprenorphine versus methadone among patients in opioid maintenance treatment. Methods: Five different randomized, controlled trials were selected from PubMed and The Cochrane Library to be included in this literature study. To limit this degree project, four variables was selected: completion and retention in treatment, use of illicit opiates during treatment and adverse events associated with treatment medication. Results: According to the findings in the five studies, methadone can be considered as a better option than buprenorphine when it comes to retaining participants in treatment. However, buprenorphine is somewhat more effective reducing the illicit use of opiates. When both methadone and buprenorphine were used in higher doses, more participants stayed in treatment. Also, higher doses were associated with a lower portion of urine samples positive for illicit opiates. Few adverse events were documented from the studies. Conclusion: Both methadone and buprenorphine have advantages and disadvantages. Since treatment with methadone is more perilous, buprenorphine should be considered as first-line treatment. But if the clinical effect remains insufficient, a transition to methadone treatment should occur, all according to the guidelines of opioid maintenance treatment in Sweden. However, future studies should consider evaluating the relationship between dose and effect of buprenorphine and possibly also methadone. Furthermore, more focus should be added on the initiation phase of treatment with buprenorphine.

Orientador: Stelio Pacca Loureiro Luna / Banca: Francisco José Teixeira Neto / Banca: Yara Cury / Resumo: O objetivo do estudo foi avaliar e comparar um analgesiômetro de estimulação nociceptiva mecânica a um de estimulação nociceptiva térmica. Para tal, foi desenvolvido um modelo experimental de determinação do limiar nociceptivo mecânico (LNM), que envolveu a produção de um foco inflamatório para avaliar os efeitos analgésicos dos antiinflamatórios não esteróides (AINES) em gatos. Oito gatos adultos castrados, pesando entre 3,4l0,6kg, foram utilizados num estudo cruzado e aleatório. O estímulo nociceptivo mecânico foi realizado por meio de um bracelete de plástico, adaptado de um manguito de pressão neonatal, colocado ao redor do antebraço e contendo três pinos de 2,4mm de diâmetro. O manguito foi inflado até a reação do animal, que foi considerado como o LNM. O estímulo nociceptivo térmico (LNT) foi realizado por meio de um dispositivo justaposto a um manguito de pressão neonatal, posicionado ao redor do tórax por uma cinta elástica. O elemento de calor era acionado e a temperatura elevada em 0,6oC/s. O estímulo foi interrompido assim que o animal reagiu. O estudo foi cego e dividido em duas fases. Na primeira, após quatro mensurações basais dos LNT e LNM, cada gato recebeu pela via SC, buprenorfina (0,01mg/kg), carprofeno (4mg/kg) ou solução fisiológica (0,3mL) em um estudo de três períodos, com uma semana de intervalo. As mensurações foram feitas aos 15, 30, 45min e 1,2,3,4,6,8 e 24h, após cada tratamento. Na segunda fase, os gatos foram anestesiados com isofluorano para a injeção intradérmica de kaolin no antebraço, para produção de um foco inflamatório. No dia 0, às -3hr, cada gato recebeu pela via subcutânea, 0,3 ml de solução fisiológia 0,9% (GS e GB) ou 4 mg/kg de carprofeno (GC)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to evaluate a prototype pressure stimulus device for cats and to compare with a known thermal threshold device. An objective model of nociceptive threshold determination on a site of mild inflammation was developed for evaluation of NSAID analgesia in cats. Eight healthy adult cats weighing between 3.0 and 4.9 kg were used in a randomized crossover study. Pressure stimulation was performed via a plastic bracelet taped around the forearm. Three 2.4mm diameter ball-bearings, in a 10mm triangle, were advanced against the craniolateral surface of the antebrachium by manual inflation of a modified blood pressure bladder. Pressure in the cuff was recorded as threshold (PT) at the behavioral end point (lifting, turning towards, leg shake and head turn). Thermal threshold (TT) was tested as previously reported by Dixon et al. (2002). Stimuli were stopped if they reached 55°C or 650mmHg without response. The study was divided in two phases. In both phases, the investigator was blinded to the treatment. In the first phase, after four pressure and thermal threshold baseline measurements, each cat received SC buprenorphine 0.01mg/kg, carprofen 4 mg/kg or saline 0.3mL in a three period study with one week interval. Measurements were made at 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8 and 24h, after injection. In the second phase, cats were anaesthetized with isoflurane and at 0h, kaolin (0.15ml of 5% suspension at 5 sites) was injected intradermally at the testing site on the forelimb to produce mild inflammation. In control treatment (SG), at -3h, cats received physiological saline (0.3ml, SC) and three baseline pressure thresholds in the forearm were recorded before cats received another injection of a similar volume at -1h... (Complete abstract, access undermentioned electronic address) / Mestre

Made available in DSpace on 2014-06-11T19:27:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-09Bitstream added on 2014-06-13T19:14:54Z : No. of bitstreams: 1 steagall_pvm_me_botfm.pdf: 548034 bytes, checksum: 9a8da28f5fb380f73f0c1d4a2494de63 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo do estudo foi avaliar e comparar um analgesiômetro de estimulação nociceptiva mecânica a um de estimulação nociceptiva térmica. Para tal, foi desenvolvido um modelo experimental de determinação do limiar nociceptivo mecânico (LNM), que envolveu a produção de um foco inflamatório para avaliar os efeitos analgésicos dos antiinflamatórios não esteróides (AINES) em gatos. Oito gatos adultos castrados, pesando entre 3,4l0,6kg, foram utilizados num estudo cruzado e aleatório. O estímulo nociceptivo mecânico foi realizado por meio de um bracelete de plástico, adaptado de um manguito de pressão neonatal, colocado ao redor do antebraço e contendo três pinos de 2,4mm de diâmetro. O manguito foi inflado até a reação do animal, que foi considerado como o LNM. O estímulo nociceptivo térmico (LNT) foi realizado por meio de um dispositivo justaposto a um manguito de pressão neonatal, posicionado ao redor do tórax por uma cinta elástica. O elemento de calor era acionado e a temperatura elevada em 0,6oC/s. O estímulo foi interrompido assim que o animal reagiu. O estudo foi cego e dividido em duas fases. Na primeira, após quatro mensurações basais dos LNT e LNM, cada gato recebeu pela via SC, buprenorfina (0,01mg/kg), carprofeno (4mg/kg) ou solução fisiológica (0,3mL) em um estudo de três períodos, com uma semana de intervalo. As mensurações foram feitas aos 15, 30, 45min e 1,2,3,4,6,8 e 24h, após cada tratamento. Na segunda fase, os gatos foram anestesiados com isofluorano para a injeção intradérmica de kaolin no antebraço, para produção de um foco inflamatório. No dia 0, às -3hr, cada gato recebeu pela via subcutânea, 0,3 ml de solução fisiológia 0,9% (GS e GB) ou 4 mg/kg de carprofeno (GC)... / The aim of this study was to evaluate a prototype pressure stimulus device for cats and to compare with a known thermal threshold device. An objective model of nociceptive threshold determination on a site of mild inflammation was developed for evaluation of NSAID analgesia in cats. Eight healthy adult cats weighing between 3.0 and 4.9 kg were used in a randomized crossover study. Pressure stimulation was performed via a plastic bracelet taped around the forearm. Three 2.4mm diameter ball-bearings, in a 10mm triangle, were advanced against the craniolateral surface of the antebrachium by manual inflation of a modified blood pressure bladder. Pressure in the cuff was recorded as threshold (PT) at the behavioral end point (lifting, turning towards, leg shake and head turn). Thermal threshold (TT) was tested as previously reported by Dixon et al. (2002). Stimuli were stopped if they reached 55°C or 650mmHg without response. The study was divided in two phases. In both phases, the investigator was blinded to the treatment. In the first phase, after four pressure and thermal threshold baseline measurements, each cat received SC buprenorphine 0.01mg/kg, carprofen 4 mg/kg or saline 0.3mL in a three period study with one week interval. Measurements were made at 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8 and 24h, after injection. In the second phase, cats were anaesthetized with isoflurane and at 0h, kaolin (0.15ml of 5% suspension at 5 sites) was injected intradermally at the testing site on the forelimb to produce mild inflammation. In control treatment (SG), at -3h, cats received physiological saline (0.3ml, SC) and three baseline pressure thresholds in the forearm were recorded before cats received another injection of a similar volume at -1h... (Complete abstract, access undermentioned electronic address)

The α₂-adrenergic receptor agonists are widely used in equine practice, especially in antalgic therapy, because they promote profound sedation and moderate visceral analgesia. The opioids are used in horses with some restriction due to the excitatory effects in this specie. The objective of this study was to evaluate the sedative effect, hemodynamic, pulmonary and digestory changes due to the neuroleptoanalgesic association of buprenorphine and different doses of xylazine. Six adults horses of both gender, weighting an average of 400 Kg. The animals were control of themselves, being divided into four groups, control group (CG) saline NaCl 0,9% solution administrated IV, and three other groups with buprenorphine 10 μg/kg associated to three different doses of xylazine, 0,25 mg/kg (BX25), 0,50 mg/kg (BX50) and 0,75 mg/kg (BX75) IV. Sedative effects, gastrointestinal motility, FC, f, SAP, MAP, DAP, blood gas tension analysis and core temperature were evaluated 30 min before, immediately before the administration of any treatment for basal values and after 5, 15 and every 15 min until 120 min post-treatment. Gastrointestinal motility was evaluated by the same period and for 12 hours, every 2 hours. Blood samples were collected at 0, 30 and 60 min. Parametric variables were analyzed with ANOVA, followed by Dunnett test for intra group and Tukey test between groups. For the non-parametric variable (intestinal motility) Wilcoxon test was used. Differences was considered significant when P<0.05. Intense sedative effect was observed in the three groups with the neuroleptoanalgesic association lasting 45 min in BX75 with profound ataxia. Intestinal motility decreased with 5 minutes after administration and remained decreased for 8 hours. Hemodynamic parameters started to increased after 30 min and no changes were observed in respiratory frequency and blood gas samples analysis, only HCO3- showed increase. Synergistic effect was observed, maintaining hemodynamic stability, with minimal pulmonary effects. The hypomotility observed must be considered when the association is used in horses with gastrointestinal disorders. / Os agonistas α₂-adrenérgicos são amplamente empregados na clínica equina, destacando-se na terapia antálgica pela intensa sedação e por produzirem moderada analgesia visceral. Os opióides, apesar de serem utilizados na terapia antálgica de equinos, parecem ainda ter seu uso relativamente restrito, principalmente pela excitação observada quando da utilização destes. O estudo teve como objetivo investigar o efeito sedativo e as alterações hemodinâmicas, pulmonares e digestória decorrentes da utilização da associação neuroleptoanalgésica entre a buprenorfina e diferentes doses de xilazina. Utilizou-se 6 equinos de ambos os sexos, com média de peso de 400kg. Os animais foram divididos em quatro grupos autocontrole, sendo grupo controle, administração de solução fisiológica 0,9% IV, e outros três grupos, com a associação de buprenorfina 10 μg/kg associada a diferentes doses de xilazina, 0,25 mg/kg (BX25), 0,5 mg/kg (BX50) e 0,75 mg/kg (BX75) IV. Avaliouse a atividade sedativa, motilidade intestinal, FC, f, PAS, PAM, PAD, parâmetros hemogasométricos e temperatura corpórea aos 30 min antes, imediatamente antes da administração de qualquer substância para determinação dos valores basais e aos 5min, 15 min, e a cada 15 min até 120 min após o tratamento. A motilidade intestinal foi avaliada pelo mesmo período nos mesmos tempos e a cada duas horas até 12 horas após a administração. Os parâmetros hemogasométricos foram avaliados aos 0, 30 e 60 min. Para as variáveis paramétricas utilizou-se análise de variância para amostras pareadas, com posterior teste de Dunnett. Para comparações entre os grupos, realizou-se análise de variância, seguido de teste de Tukey. Para a variável não-paramétrica, motilidade intestinal, utilizou-se teste de Wilcoxon para amostras pareadas. As diferenças foram consideradas significantes quando P<0,05. Foi observado efeito sedativo significante nos três grupos com a associação neuroleptoanalgésica, perdurando por até 45 min no BX75 com severa ataxia. Observou-se hipomotilidade 5 minutos após a administração perdurando por 480 min. Os parâmetros hemodinâmicos elevaram-se após os 45 min, não sendo observadas alterações na frequência respiratória e nos parâmetros hemogasométricos, ocorrendo aumento somente no HCO3-. Conclui-se que houve efeito sinérgico entre os dois fármacos, mantendo estabilidade hemodinâmica, com mínimas alterações pulmonares. A hipomotilidade promovida pela associação deve ser considerada quando usada em equinos com distúrbios gastrintestinais.

Orientador: Stelio Pacca Loureiro Luna / Banca: Juliana Tabarelli Brondani / Banca: Suzane Lilian Beier / Resumo: A via de administração de um fármaco pode influenciar sobejamente na latência e duração do efeito analgésico. Objetivou-se avaliar a sedação e a analgesia de 0,01 mg/kg de buprenorfina administrada pelas vias intravenosa (IV), intramuscular (IM), transmucosa (TM) ou subcutânea (SC) em gatas submetidas à ovariohisterectomia. Cem gatas 100 de diversas raças, com idade de quatro meses a seis anos de idade foram divididas de forma aleatória em 4 grupos de acordo com as vias de administração citadas anteriormente. Os animais foram avaliados quanto a presença dor pós-operatória e sedação antes e 1, 2, 3, 4, 6, 8, 12, e 24 h após o término do procedimento cirúrgico, por meio das escalas analógica visual interativa e dinâmica (EAVID) e descritiva simples (EDS). Realizou-se analgesia resgate com 0,02 mg/kg de buprenorfina IM quando o escore de dor foi igual ou superior a 50% da EDS ou EAVID. Para um segundo resgate analgésico foi administrado 4,4 mg/kg de carprofeno SC. Os dados paramétricos foram analisados pela ANOVA, seguida do teste de Tukey e os não paramétricos pelo teste de Kruskal-Wallis, seguido do teste de Dunn. Diferenças ao longo do tempo dentro de cada grupo foram avaliadas pelo teste de Friedman, seguido do teste de Dunn. Imediatamente após cirurgia os escores de sedação da EAVID e EDS aumentaram significantemente quando comparado ao pré-operatório, reduzindo para zero 24 horas após cirurgia. Para os escores de dor da EAVID não se observou diferença significante entre GTM e GSC e entre GIM e GIV. Os valores de GTM foram significantemente maiores quando comparados à GIV à 1h e à GIM às 3,4,6,8 e 12 h. Os valores de GSC foram significantemente maiores quando comparados à GIV às 2 h e à GIM às 2,3,4,8,12 e 24 h. No total, quatro animais do GIM (16%), seis do GIV (24%), treze do GSC (52%) e dezessete do GTM (68%) necessitaram de analgesia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The route of administration of a drug may influence the onset and duration of analgesic effect. The aim of this study was to investigate the degree of sedation and analgesia of 0.01 mg/kg of buprenorphine administered by intravenous (IV), intramuscular (IM), transmucosal (TM) or subcutaneous (SC) route in cats subjected to ovariohysterectomy. One hundred cats from different breeds, aging from four months to six years of age were randomly divided into four groups according to the above routes of administration. The animals were evaluated for the presence of postoperative pain and sedation before and 1, 2, 3, 4, 6, 8, 12, and 24 h after the surgical procedure, using dynamic interactive visual analogue scale (DIVAS) and simple descriptive scale (SDS). Rescue analgesia was performed with 0.02 mg/kg of buprenorphine IM when the pain score was more than 50% of the SDS or DIVAS. A second rescue analgesia was performed with 4.4 mg/kg of carprofen SC. The parametric data were analyzed by ANOVA followed by Tukey's test and the non-parametric data by Kruskal-Wallis, followed by Dunn's test. Differences over time within each group were evaluated by Friedman's test, followed by the Dunn's test. The SDS and DIVAS sedation scores increased significantly immediately after surgery when compared to pre-operative values, reducing to zero, 24 h after surgery. There was no significant difference for the DIVAS pain scores between GTM and GSC and between GIM and GIV. The values of GTM were significantly greater when compared to the GIV at 1h and to GIM at 3, 4, 6, 8 and 12 h. The values of GSC were significantly higher when compared to GIV at 2 h and to the GIM at 2, 3, 4, 8, 12 and 24 h. In total, four animals from GIM (16%), six from GIV (24%), thirteen from GSC (52%) and seventeen from GTM (68%) needed rescue analgesia. The total number of rescue analgesic in GTM was significantly higher than... (Complete abstract click electronic access below) / Mestre

Orientador: Stelio Pacca Loureiro Luna / Banca: André Leguthe / Banca: Renata Navarro Cassu / Banca: Juliana Brondani / Banca: Guilherme Barros / Resumo: O objetivo do estudo foi avaliar os efeitos antinociceptivos da buprenorfina em gatos, quando administrada em diferentes doses pela via intravenosa (IV), e também por diferentes vias de administração, por meio da mensuração do limiar nociceptivo térmico (LNT) e mecânico (LNM) num estudo cruzado, cego e aleatório. O estímulo nociceptivo térmico (LNT) foi realizado por meio de um dispositivo justaposto a um mangüito de pressão neonatal, posicionado ao redor do tórax do gato por uma cinta elástica. O estímulo nociceptivo mecânico foi realizado por meio de um bracelete de plástico, colocado ao redor do antebraço do gato. Na primeira fase, após as mensurações basais dos LNT e LNM, oito gatos (3,8±0,6kg) receberam buprenorfina (IV) nas doses de 0,01 (B1), 0,02 (B2) e 0,04 (B4) mg/kg. As mensurações foram feitas até 10h após cada tratamento. Na segunda fase, após as mensurações basais dos LNT, seis gatos (4,1±0,5kg) receberam buprenorfina (0,02 mg/kg) pelas vias IV, intramuscular (IM) e subcutânea (SC). As mensurações foram realizadas até 24h após cada tratamento. Na terceira fase, após as mensurações basais dos LNT e LNM, oito gatos (4,7±1,5kg) receberam buprenorfina (0,02 mg/kg) pela via epidural, por meio de uma via de acesso vascular implantada cirurgicamente antes do início do estudo. As mensurações foram realizadas até 24h após cada tratamento. Os dados foram analisados por ANOVA (P<0,05). Os LNT e LNM acima do intervalo de confiança de 95% (IC95%), gerados pelos valores basais, indicaram antinocicepção. Na primeira fase, os LNT e os LNM aumentaram significativamente entre 15min e 4h (LNT) após B1, entre 15min e 2h e aos 15 e 45min após B2, e entre 15min e 8h, exceto às 4h, e entre 30min e 2h, após B4, respectivamente. Aos 45min, os LNM foram significativamente maiores em B2 quando comparados a B1. As médias dos LNT e dos LNM ficaram... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The aim of this study was to evaluate the antinociceptive effects of buprenorphine in cats after intravenous (IV) administration of different doses and after different routes of administration, by means of measuring thermal (TT) and mechanical (MT) nociceptive thresholds, in a randomized, blinded and crossover study. Thermal stimulation was given via a probe, attached to an elasticated band and positioned around the cat's thorax with an inflated modified neonatal cuff. Mechanical stimulation was given via a plastic bracelet with a modified neonatal cuff, taped around the cat's antebrachium. In the first phase, after MT and TT baseline recordings, eight cats (3.8±0.6kg) were given 0.01 (B1), 0.02 (B2) and 0.04 (B4) mg/kg of buprenorphine IV. Thresholds were measured until 10h after administration of treatments. In the second phase, after TT baseline recordings, buprenorphine (0.02 mg/kg) was administered to six cats (4.1±0.5kg) by the IV, intramuscular (IM) and subcutaneous (SC) routes. Threshold measurements were performed up to 24h after treatments. In the third phase, after TT and MT baseline recordings, eight cats (4.7±1.5kg) received buprenorphine (0.02 mg/kg), through a vascular access port that had been surgically implanted in the epidural space. TT and MT were measured up to 24h after each treatment. Data were analyzed by ANOVA (P<0.05). A 95% confidence interval (IC95%) was generated by the baseline values. Thresholds above IC95% indicated antinociception. In the first phase, compared to baseline, TT were significantly increased between 15min and 4h after B1, between 15min and 2h after B2, and between 15min and 8h, expect at 4h, after B4. MT was significantly increased at 15 and 45min after B2 and between 30min and 2h after B4. At 45min, MT were significantly higher in B2 compared to B1. Mean TT were above the IC95% from 15min to 10h in all groups. Mean MT were... (Complete abstract click electronic access below) / Doutor

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals. Opioid use disorder (OUD)-related hospitalizations are increasing, and incurring significant costs; care delivered in this setting is likely sub-optimal. This study examined hospital-based services for OUD using a conceptual framework based on an interdisciplinary review of policy, organizational behavior, systems science, economics, and health services delivery scholarship. The study's primary research question was: How do supply-side attributes influence hospital OAT delivery, health outcomes, and health services utilization for persons hospitalized with OUD? Supply-side attributes refer to the contextual elements inside and outside of a hospital that may be associated with hospital OAT delivery performance, such as social structures (e.g., hospital standards of care, societal values) and resources and technologies (e.g., hospital staffing, federal treatment policies). A mixed methods study described, explored, and identified how patients with OUD are cared for in the hospital and the barriers and facilitators to delivering OAT during hospitalization. The sequential mixed methods approach (i.e., qualitative followed by quantitative analyses) included analysis of 17 key informant interviews with addiction medicine physicians from 16 non-federal U.S. hospitals, 25 hospital guidance documents from 10 non-federal U.S. hospitals, and administrative data from 12,407 OUD-related hospital admissions from the Veterans Health Administration (VHA) health system. The findings from the study's three aims and 16 research sub-questions were integrated to reach seven conclusions: 1) OAT is underused in the hospital; 2) OAT delivery varies within and across hospitals; 3) OAT is used ineffectively; 4) non-OAT modalities are inappropriately used during and after hospitalization; 5) supply-side attributes inside and outside the hospital facilitate and impede hospital OAT delivery; 6) demand-side attributes facilitate and impede hospital OAT delivery; and 7) the hospital is an important service delivery mechanism in the OUD care continuum. The study's findings could be extrapolated to improve policy and practice by implementing education and health service delivery interventions through regulatory and allocative policy mechanisms focused on physicians, medical trainees, and hospital and health system administrators. Understanding how OAT delivery may be improved within the acute care delivery system is an important element to support efforts to curb the ongoing drug poisoning crisis.

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The mortality in drug related deaths has increased in many countries, calling it an epidemic. Overdose caused by opioids have contributed to the increasing drug related deaths. This study aims to examine and compile which methods and strategies have shown to reduce the mortality in drug related deaths. Using a systematic review and no limitation to countries a mix of methods and strategies was found. Some Ministries of Health department list them as important in reducing damages and risk behavior related to addiction. The repressive approach that was historically dominated has shown less successful. Individuals own strengths and access to treatments and strategies are momentous. It is also of great importance that governments and health care applies the listed methods and strategies. Blood diseases have decreased with needle exchange programs as a result of having implemented the method. Medications for addiction treatment are improving living conditions for people with opioid addiction. Still there are problems and difficulties with access to addiction treatment and harm reduction strategies. Stigma and the historical perception of drug use and addiction are some of the reasons for the inaccessibility and lack of harm reduction strategies.