O objetivo do presente estudo foi avaliar a eficácia da analgesia preemptiva na cirurgia de extração de terceiros molares inclusos. Nesse estudo duplo cego, randomizado e pareado, os pacientes foram submetidos à extração de terceiros molares inferiores bilaterais em dois tempos distintos. Em uma das duas cirurgias, no pré-operatório os pacientes fizeram uso de Cetoprofeno 150 mg via oral a cada 12 horas durante dois dias antes e, após a cirurgia, continuaram a medicação por mais três dias. Em outra cirurgia, fizeram uso de um comprimido placebo no pré-operatório a cada 12 horas durante dois dias antes e, após a cirurgia, fizeram uso de Cetoprofeno 150 mg a cada 12 horas por três dias. O analgésico de resgate utilizado foi o Paracetamol 750 mg via oral. A dor pós-operatória foi avaliada por meio de Escala Visual Analógica, Escala Nominal e quantidade de consumo de analgésicos de resgate. Os resultados não mostraram diferença significante entre o controle e cetoprofeno preemptivo na redução da dor pós-operatória e no consumo de analgésicos de resgate. Concluiu-se que neste modelo experimental, a analgesia preemptiva não se mostrou eficaz na redução da dor pós-operatória. / The aim of this study was to evaluate the effectiveness of the preemptive analgesia in the third molar surgery. In this double blind study, randomized and paired, the patients were submitted to the extraction of the third molar bilateral inferiors in two distinct times. In one of the two surgeries, during the two-day preoperative the patients made useof150 mg of ketoprofenoralevery12 hours and, after the surgery, they kept taking this medication for three days. In the other surgery, a placebo pill was used in the preoperative, also every 12 hours, for two days and, after the surgery, ketoprofen 150 mg was used every 12 hours for three days. The rescue analgesic used was the paracetamol 750 mg oral. Postoperative pain was evaluated by making use of the Analogical Visual Scale, the Nominal Scale and the amount of rescue analgesic consumption. The results did not show significant difference between the control and the preemptive ketoprofen in the reduction of postoperative pain and in the rescue analgesic consumption. We can conclude that in this experimental model, the preemptive analgesia did not prove to be efficient in the reduction of postoperative pain.

O objetivo do presente estudo foi avaliar a eficácia da analgesia preemptiva na cirurgia de extração de terceiros molares inclusos. Nesse estudo duplo cego, randomizado e pareado, os pacientes foram submetidos à extração de terceiros molares inferiores bilaterais em dois tempos distintos. Em uma das duas cirurgias, no pré-operatório os pacientes fizeram uso de Cetoprofeno 150 mg via oral a cada 12 horas durante dois dias antes e, após a cirurgia, continuaram a medicação por mais três dias. Em outra cirurgia, fizeram uso de um comprimido placebo no pré-operatório a cada 12 horas durante dois dias antes e, após a cirurgia, fizeram uso de Cetoprofeno 150 mg a cada 12 horas por três dias. O analgésico de resgate utilizado foi o Paracetamol 750 mg via oral. A dor pós-operatória foi avaliada por meio de Escala Visual Analógica, Escala Nominal e quantidade de consumo de analgésicos de resgate. Os resultados não mostraram diferença significante entre o controle e cetoprofeno preemptivo na redução da dor pós-operatória e no consumo de analgésicos de resgate. Concluiu-se que neste modelo experimental, a analgesia preemptiva não se mostrou eficaz na redução da dor pós-operatória. / The aim of this study was to evaluate the effectiveness of the preemptive analgesia in the third molar surgery. In this double blind study, randomized and paired, the patients were submitted to the extraction of the third molar bilateral inferiors in two distinct times. In one of the two surgeries, during the two-day preoperative the patients made useof150 mg of ketoprofenoralevery12 hours and, after the surgery, they kept taking this medication for three days. In the other surgery, a placebo pill was used in the preoperative, also every 12 hours, for two days and, after the surgery, ketoprofen 150 mg was used every 12 hours for three days. The rescue analgesic used was the paracetamol 750 mg oral. Postoperative pain was evaluated by making use of the Analogical Visual Scale, the Nominal Scale and the amount of rescue analgesic consumption. The results did not show significant difference between the control and the preemptive ketoprofen in the reduction of postoperative pain and in the rescue analgesic consumption. We can conclude that in this experimental model, the preemptive analgesia did not prove to be efficient in the reduction of postoperative pain.

O uso da Estimulação Elétrica Transcutânea do Nervo (TENS) vem sendo muito pesquisado em pós-operatórios, todavia os estudos não analisam se a TENS de baixa freqüência -- que estimula a liberação de opióides endógenos -- seria eficiente em promover analgesia preemptiva. Objetivo. Analisar se essa modalidade de TENS, aplicada antes de colecistectomias por laparotomia, poderia proporcionar analgesia preemptiva. Casuística e método. A pesquisa -- clínica, controlada, randomizada e duplamente encoberta -- foi realizada no Hospital São Domingos Sávio, e teve uma amostra de 50 pacientes, todas do sexo feminino: grupo preemptivo (n = 25) e placebo (n = 25). As pacientes do primeiro grupo foram submetidas à aplicação da TENS de baixa freqüência antes da cirurgia: e as do grupo placebo, a uma falsa estimulação. Houve a padronização do cloridrato de bupivacaína (0,5%) como droga anestésica, associado ao fentanil (2 ml) para a realização das colecistectomias; e da medicação analgésica utilizada no pós-operatório: dipirona, prescrita de 6 em 6 horas, e diclofenaco de sódio, como medicação de resgate. A intensidade de dor pós-operatória foi mensurada pela Escala Numérica de Mensuração da Dor (END), em 8 momentos (2½, 3½, 4½, 5½, 7, 8 e 16 horas após a indução do bloqueio anestésico, além de uma última verificação no momento da alta hospitalar), e pelo Questionário de Dor McGill (MPQ), aplicado 16 horas após a indução do bloqueio anestésico. Outrossim, o grau de satisfação das pacientes com o tratamento foi mensurado pela Escala de Satisfação do Paciente (ESP). Os dados foram analisados por meio de testes estatísticos descritivos, Teste de Mann-Whitney, Teste-t de Student para amostras não-pareadas e qui-quadrado, sendo o nível de significância de 5%. Resultados. A intensidade de dor, mensurada pela END, foi significantemente menor no grupo preemptivo nas terceira e quarta coletas. Não houve diferença significante quanto aos índices obtidos pelo MPQ, e nem quanto à satisfação das pacientes, o consumo de drogas analgésicas no pós-operatório e o tempo para o primeiro requerimento de diclofenaco de sódio. Conclusão. A TENS de baixa freqüência proporcionou analgesia preemptiva após colecistectomia por laparotomia. / Introduction. Transcutaneous Electrical Nerve Stimulation (TENS) has been searched in the postoperative period, however these studies don\'t analyze whether low frequency TENS -- that stimulates the release of endogenous opioids -- could be efficient to provide preemptive analgesia. Objective. The aim of this study was to verify whether low frequency TENS, applied before open cholecystectomies, could provide it. Cases and method. It was a controlled, randomized and double-blinded trial, carried out at the Hospital São Domingos Sávio (Aracaju city, Brazil), and had a sample of 50 patients: preemptive group (n = 25) and placebo (n = 25). The patients from the first group were submitted to the application of TENS before the surgery; and the placebo group to a false stimulation. There was the standardization of the bupivacaine (0,5 %) as anesthetic drug plus fentanyl (2 ml) for the accomplishment of the cholecystectomies; and of the analgesic medication used in the postoperative period: dipyrone, prescribed for every 6 hours, and diclofenac, only if the patients complained about pain. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3½, 4½, 5½, 7, 8 e 16 hours after inducing the anesthesia besides one last verification at the hospital discharge), and by the Brazilian version of the McGill Pain Questionnaire (Br-MPQ), applied 16 hours after inducing the anesthesia. Patient satisfaction level in relation to the treatment was measured by the Patient Satisfaction Scale (PSS). The data were analyzed by Mann-Whitney Test, unpaired t-test and qui-square, being significant, those data with p < 0,05. Results. Pain intensity, measured by the NRS, was lower in the preemptive group in the third and fourth verifications. There was no difference neither in relation to the indexes obtained with the Br-MPQ, nor the PSS, consume of analgesics in the postoperative and time for the first request of diclofenac. Conclusion. Low frequency TENS provided preemptive analgesia after open cholecystectomy.

O uso da Estimulação Elétrica Transcutânea do Nervo (TENS) vem sendo muito pesquisado em pós-operatórios, todavia os estudos não analisam se a TENS de baixa freqüência -- que estimula a liberação de opióides endógenos -- seria eficiente em promover analgesia preemptiva. Objetivo. Analisar se essa modalidade de TENS, aplicada antes de colecistectomias por laparotomia, poderia proporcionar analgesia preemptiva. Casuística e método. A pesquisa -- clínica, controlada, randomizada e duplamente encoberta -- foi realizada no Hospital São Domingos Sávio, e teve uma amostra de 50 pacientes, todas do sexo feminino: grupo preemptivo (n = 25) e placebo (n = 25). As pacientes do primeiro grupo foram submetidas à aplicação da TENS de baixa freqüência antes da cirurgia: e as do grupo placebo, a uma falsa estimulação. Houve a padronização do cloridrato de bupivacaína (0,5%) como droga anestésica, associado ao fentanil (2 ml) para a realização das colecistectomias; e da medicação analgésica utilizada no pós-operatório: dipirona, prescrita de 6 em 6 horas, e diclofenaco de sódio, como medicação de resgate. A intensidade de dor pós-operatória foi mensurada pela Escala Numérica de Mensuração da Dor (END), em 8 momentos (2½, 3½, 4½, 5½, 7, 8 e 16 horas após a indução do bloqueio anestésico, além de uma última verificação no momento da alta hospitalar), e pelo Questionário de Dor McGill (MPQ), aplicado 16 horas após a indução do bloqueio anestésico. Outrossim, o grau de satisfação das pacientes com o tratamento foi mensurado pela Escala de Satisfação do Paciente (ESP). Os dados foram analisados por meio de testes estatísticos descritivos, Teste de Mann-Whitney, Teste-t de Student para amostras não-pareadas e qui-quadrado, sendo o nível de significância de 5%. Resultados. A intensidade de dor, mensurada pela END, foi significantemente menor no grupo preemptivo nas terceira e quarta coletas. Não houve diferença significante quanto aos índices obtidos pelo MPQ, e nem quanto à satisfação das pacientes, o consumo de drogas analgésicas no pós-operatório e o tempo para o primeiro requerimento de diclofenaco de sódio. Conclusão. A TENS de baixa freqüência proporcionou analgesia preemptiva após colecistectomia por laparotomia. / Introduction. Transcutaneous Electrical Nerve Stimulation (TENS) has been searched in the postoperative period, however these studies don\'t analyze whether low frequency TENS -- that stimulates the release of endogenous opioids -- could be efficient to provide preemptive analgesia. Objective. The aim of this study was to verify whether low frequency TENS, applied before open cholecystectomies, could provide it. Cases and method. It was a controlled, randomized and double-blinded trial, carried out at the Hospital São Domingos Sávio (Aracaju city, Brazil), and had a sample of 50 patients: preemptive group (n = 25) and placebo (n = 25). The patients from the first group were submitted to the application of TENS before the surgery; and the placebo group to a false stimulation. There was the standardization of the bupivacaine (0,5 %) as anesthetic drug plus fentanyl (2 ml) for the accomplishment of the cholecystectomies; and of the analgesic medication used in the postoperative period: dipyrone, prescribed for every 6 hours, and diclofenac, only if the patients complained about pain. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3½, 4½, 5½, 7, 8 e 16 hours after inducing the anesthesia besides one last verification at the hospital discharge), and by the Brazilian version of the McGill Pain Questionnaire (Br-MPQ), applied 16 hours after inducing the anesthesia. Patient satisfaction level in relation to the treatment was measured by the Patient Satisfaction Scale (PSS). The data were analyzed by Mann-Whitney Test, unpaired t-test and qui-square, being significant, those data with p < 0,05. Results. Pain intensity, measured by the NRS, was lower in the preemptive group in the third and fourth verifications. There was no difference neither in relation to the indexes obtained with the Br-MPQ, nor the PSS, consume of analgesics in the postoperative and time for the first request of diclofenac. Conclusion. Low frequency TENS provided preemptive analgesia after open cholecystectomy.

Introdução. O uso da Estimulação Elétrica Nervosa Transcutânea (TENS) para o tratamento da dor pós-operatória tem sido objeto de estudo há alguns anos. Todavia, em quase a totalidade dos trabalhos, a TENS foi aplicada somente após os procedimentos cirúrgicos, à exceção de uma única pesquisa em que foi empregada no período pré-operatório. Em ambas as situações, esse recurso foi eficiente para o tratamento da dor, seja por meio da redução da sua intensidade ou do consumo de analgésicos. Porém, ainda hoje, não se sabe qual o papel que o seu momento de aplicação (somente antes da cirurgia; apenas após a operação; ou antes e após) pode vir a exercer no grau de analgesia obtido. Objetivo. Analisar a influência do momento de aplicação da TENS, na modalidade de alta freqüência, como recurso analgésico em pacientes do sexo masculino submetidos a herniorrafias inguinais pela técnica de Bassini. Casuística e método. A pesquisa clínica, controlada, aleatória e duplamente encoberta foi realizada no Hospital São José, entre abril de 2007 e junho de 2008, com amostra de 125 pacientes, distribuídos em 5 grupos: TENS depois (n = 25), TENS antes (n = 25), TENS antes e depois (n = 25), Placebo (n = 25) e Controle (n = 25). Todas as anestesias foram realizadas via raquidiana, com cloridrato de bupivacaína (0,5%); e a medicação analgésica utilizada no pós-operatório foi: dipirona, como medicação de resgate; e cetoprofeno, em horário programado. A mensuração da dor foi feita com a escala numérica (0-10 cm) e com a versão brasileira do Questionário de Dor McGill (Br-MPQ). Foram considerados estatisticamente significantes os valores de p 0,05. Resultados. Os grupos que foram tratados com a TENS apresentaram redução significante da dor, sendo os resultados mais expressivos naqueles pacientes em que a TENS foi aplicada tanto no período pré, quanto pós-operatório (TENS antes e depois). Houve também redução significante da administração de dipirona no período pós-operatório. Conclusão. O uso pré e pós-operatório da modalidade de alta freqüência da TENS, em pacientes submetidos a herniorrafias inguinais com técnica de Bassini, proporcionou analgesia mais satisfatória do que aquela obtida somente com a aplicação em um desses momentos. / Introduction. The use of Transcutaneous Electrical Nerve Stimulation (TENS) to treat postoperative pain has been searched lately. However, in the most of studies, TENS has been applied only after surgeries, excepting one where TENS was utilized before. In the two situations, this resource has presented good benefits for pain treatment, observed not only by a reduction in its intensity but also in consumption of analgesics. Nevertheless, there is a doubt about the role that TENS applications moment can exert in analgesias level obtained in the postoperative period. Objective. To analyze the influence of applications moment of high frequency TENS as an analgesic resource in male patients submitted to inguinal herniorraphy (Bassini technique). Cases and method. It was a placebo-controlled, randomized and double-blinded trial, carried out at the Hospital São José (Aracaju, SE, Brazil), between April 2007 and June 2008, and had a sample of 125 patients, distributed in 5 groups: pre TENS (n = 25), post TENS (n = 25), pre- and post TENS (n = 25), Sham (n = 25) and Control (n = 25). There was the standardization of the bupivacaine (0,5 %) as an anesthetic drug, as well as postoperative analgesic prescription: dipyrone, only if the patient complained about pain; and ketoprofen, prescribed for every 8 h. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3, 3½, 4, 5, 6 and 7 h after inducing the anesthesia besides one last verification at the hospital discharge). Brazilian version of the McGill Pain Questionnaire (Br-MPQ) was used 4 h following the inducing of the anesthesia. P values .05 were considered significant. Results. Patients treated with TENS showed less pain intensity, and the most expressive results occurred in pre- and post TENS, moreover there was also significant reduction in dipyrone consumption. Conclusion. The pre- and postoperative use of high frequency TENS in inguinal herniorraphy provided major analgesia than the one obtained by TENS application only in the pre- or postoperative period.

Introdução. O uso da Estimulação Elétrica Nervosa Transcutânea (TENS) para o tratamento da dor pós-operatória tem sido objeto de estudo há alguns anos. Todavia, em quase a totalidade dos trabalhos, a TENS foi aplicada somente após os procedimentos cirúrgicos, à exceção de uma única pesquisa em que foi empregada no período pré-operatório. Em ambas as situações, esse recurso foi eficiente para o tratamento da dor, seja por meio da redução da sua intensidade ou do consumo de analgésicos. Porém, ainda hoje, não se sabe qual o papel que o seu momento de aplicação (somente antes da cirurgia; apenas após a operação; ou antes e após) pode vir a exercer no grau de analgesia obtido. Objetivo. Analisar a influência do momento de aplicação da TENS, na modalidade de alta freqüência, como recurso analgésico em pacientes do sexo masculino submetidos a herniorrafias inguinais pela técnica de Bassini. Casuística e método. A pesquisa clínica, controlada, aleatória e duplamente encoberta foi realizada no Hospital São José, entre abril de 2007 e junho de 2008, com amostra de 125 pacientes, distribuídos em 5 grupos: TENS depois (n = 25), TENS antes (n = 25), TENS antes e depois (n = 25), Placebo (n = 25) e Controle (n = 25). Todas as anestesias foram realizadas via raquidiana, com cloridrato de bupivacaína (0,5%); e a medicação analgésica utilizada no pós-operatório foi: dipirona, como medicação de resgate; e cetoprofeno, em horário programado. A mensuração da dor foi feita com a escala numérica (0-10 cm) e com a versão brasileira do Questionário de Dor McGill (Br-MPQ). Foram considerados estatisticamente significantes os valores de p 0,05. Resultados. Os grupos que foram tratados com a TENS apresentaram redução significante da dor, sendo os resultados mais expressivos naqueles pacientes em que a TENS foi aplicada tanto no período pré, quanto pós-operatório (TENS antes e depois). Houve também redução significante da administração de dipirona no período pós-operatório. Conclusão. O uso pré e pós-operatório da modalidade de alta freqüência da TENS, em pacientes submetidos a herniorrafias inguinais com técnica de Bassini, proporcionou analgesia mais satisfatória do que aquela obtida somente com a aplicação em um desses momentos. / Introduction. The use of Transcutaneous Electrical Nerve Stimulation (TENS) to treat postoperative pain has been searched lately. However, in the most of studies, TENS has been applied only after surgeries, excepting one where TENS was utilized before. In the two situations, this resource has presented good benefits for pain treatment, observed not only by a reduction in its intensity but also in consumption of analgesics. Nevertheless, there is a doubt about the role that TENS applications moment can exert in analgesias level obtained in the postoperative period. Objective. To analyze the influence of applications moment of high frequency TENS as an analgesic resource in male patients submitted to inguinal herniorraphy (Bassini technique). Cases and method. It was a placebo-controlled, randomized and double-blinded trial, carried out at the Hospital São José (Aracaju, SE, Brazil), between April 2007 and June 2008, and had a sample of 125 patients, distributed in 5 groups: pre TENS (n = 25), post TENS (n = 25), pre- and post TENS (n = 25), Sham (n = 25) and Control (n = 25). There was the standardization of the bupivacaine (0,5 %) as an anesthetic drug, as well as postoperative analgesic prescription: dipyrone, only if the patient complained about pain; and ketoprofen, prescribed for every 8 h. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3, 3½, 4, 5, 6 and 7 h after inducing the anesthesia besides one last verification at the hospital discharge). Brazilian version of the McGill Pain Questionnaire (Br-MPQ) was used 4 h following the inducing of the anesthesia. P values .05 were considered significant. Results. Patients treated with TENS showed less pain intensity, and the most expressive results occurred in pre- and post TENS, moreover there was also significant reduction in dipyrone consumption. Conclusion. The pre- and postoperative use of high frequency TENS in inguinal herniorraphy provided major analgesia than the one obtained by TENS application only in the pre- or postoperative period.

Essai cinique randomisé / Objectifs : Démontrer la supériorité de l’analgésie périopératoire optimale par rapport aux traitements analgésiques usuels ou conventionnels pour diminuer l'intensité de la douleur aiguë postopératoire (DAPO), la fréquence d'apparition de la douleur chronique post chirurgicale (DCPC) et améliorer la qualité de vie des patients. Méthodes : Un essai clinique randomisé à double insu, sur 57 patients ayant subi une trapéziectomie à l'hôpital Notre-Dame du CHUM. Après avoir reçu une analgésie locorégionale via un cathéter du plexus brachial, le groupe expérimental a reçu une perfusion de bupivacaïne 0,5%, débutée dans la salle de réveil et poursuivie pendant 72 h en ambulatoire, grâce à une pompe à perfusion. Le groupe de contrôle a reçu une solution saline. Les deux groupes ont reçu du célécoxib durant cette même période. L'évolution du profil de la douleur, du fonctionnement de la main et de la qualité de vie des patients ont été saisis à l'aide de questionnaires et de tests fonctionnels en préopératoire et pendant six mois de suivi. Les résultats ont été analysés à l'aide du modèle linéaire général. Une différence de 2 au niveau de l'intensité de la douleur, mesurée par l'échelle visuelle analogique (EVA : 0-10), a été considérée statistiquement significative. Résultats : Notre méthode a abouti à une diminution significative de l'intensité de la DAPO et de la douleur chronique (DC) par rapport à la méthode conventionnelle. Les activités générales, la qualité du sommeil et la concentration des patients étaient significativement meilleures chez le groupe qui a reçu la nouvelle méthode. De plus, dans ce groupe il y avait deux fois moins des patients qui ont continué à souffrir de DC que le groupe de contrôle. Conclusion : Dans la chirurgie de la main, une couverture analgésique périopératoire est essentielle pour réduire l’intensité de la DAPO, la fréquence de la DCPC et pour améliorer la qualité de vie des patients. Mots-clés : essai clinique, douleur chronique, chirurgie, main, analgésie préventive, plexus brachial. / Objectives: Demonstrate the superiority of Optimal Perioperative Analgesia compared to Usual Analgesic Treatment to reduce the intensity of Acute Postoperative Pain (APOP), the frequency of occurrence of Chronic Post Surgical Pain (CPSP) and improve patients’ quality of life. Methods: A double-blinded randomized clinical trial conducted in Notre-Dame Hospital on 57 patients who underwent a trapeziectomy. After locoregional analgesia via a catheter in the brachial plexus, the experimental group received an infusion of bupivacaine 0.5%, which started in the recovery room and continued for 72 h as an outpatient through an infusion pump. Meanwhile, the control group received a saline solution. Both groups took celecoxib during the same period. The evolution of pain profile, hand function and patients’ quality of life have been obtained using questionnaires and functional tests in the preoperative period and through months of follow-up. Results were analyzed using General Linear Model. A difference of 2 in the intensity of pain, measured by Visual Analogue Scale (VAS: 0-10), was considered statistically significant. Results: This method resulted in a significant decrease in the intensity of APOP and Chronic Pain (CP) compared to usual treatment. General activities, quality of sleep and patients’ concentration were better in the experimental group. Moreover, two times less patients continued to suffer from the CP than in the placebo group. Conclusion: In hand surgery, a perioperative analgesic coverage is necessary to reduce the APOP intensity, the CPSP frequency and to improve patients’ quality of life. Keywords: clinical trial, chronic pain, surgery, hand, preemptive analgesia, brachial plexus.

Objectifs : Démontrer la supériorité de l’analgésie périopératoire optimale par rapport aux traitements analgésiques usuels ou conventionnels pour diminuer l'intensité de la douleur aiguë postopératoire (DAPO), la fréquence d'apparition de la douleur chronique post chirurgicale (DCPC) et améliorer la qualité de vie des patients. Méthodes : Un essai clinique randomisé à double insu, sur 57 patients ayant subi une trapéziectomie à l'hôpital Notre-Dame du CHUM. Après avoir reçu une analgésie locorégionale via un cathéter du plexus brachial, le groupe expérimental a reçu une perfusion de bupivacaïne 0,5%, débutée dans la salle de réveil et poursuivie pendant 72 h en ambulatoire, grâce à une pompe à perfusion. Le groupe de contrôle a reçu une solution saline. Les deux groupes ont reçu du célécoxib durant cette même période. L'évolution du profil de la douleur, du fonctionnement de la main et de la qualité de vie des patients ont été saisis à l'aide de questionnaires et de tests fonctionnels en préopératoire et pendant six mois de suivi. Les résultats ont été analysés à l'aide du modèle linéaire général. Une différence de 2 au niveau de l'intensité de la douleur, mesurée par l'échelle visuelle analogique (EVA : 0-10), a été considérée statistiquement significative. Résultats : Notre méthode a abouti à une diminution significative de l'intensité de la DAPO et de la douleur chronique (DC) par rapport à la méthode conventionnelle. Les activités générales, la qualité du sommeil et la concentration des patients étaient significativement meilleures chez le groupe qui a reçu la nouvelle méthode. De plus, dans ce groupe il y avait deux fois moins des patients qui ont continué à souffrir de DC que le groupe de contrôle. Conclusion : Dans la chirurgie de la main, une couverture analgésique périopératoire est essentielle pour réduire l’intensité de la DAPO, la fréquence de la DCPC et pour améliorer la qualité de vie des patients. Mots-clés : essai clinique, douleur chronique, chirurgie, main, analgésie préventive, plexus brachial. / Objectives: Demonstrate the superiority of Optimal Perioperative Analgesia compared to Usual Analgesic Treatment to reduce the intensity of Acute Postoperative Pain (APOP), the frequency of occurrence of Chronic Post Surgical Pain (CPSP) and improve patients’ quality of life. Methods: A double-blinded randomized clinical trial conducted in Notre-Dame Hospital on 57 patients who underwent a trapeziectomy. After locoregional analgesia via a catheter in the brachial plexus, the experimental group received an infusion of bupivacaine 0.5%, which started in the recovery room and continued for 72 h as an outpatient through an infusion pump. Meanwhile, the control group received a saline solution. Both groups took celecoxib during the same period. The evolution of pain profile, hand function and patients’ quality of life have been obtained using questionnaires and functional tests in the preoperative period and through months of follow-up. Results were analyzed using General Linear Model. A difference of 2 in the intensity of pain, measured by Visual Analogue Scale (VAS: 0-10), was considered statistically significant. Results: This method resulted in a significant decrease in the intensity of APOP and Chronic Pain (CP) compared to usual treatment. General activities, quality of sleep and patients’ concentration were better in the experimental group. Moreover, two times less patients continued to suffer from the CP than in the placebo group. Conclusion: In hand surgery, a perioperative analgesic coverage is necessary to reduce the APOP intensity, the CPSP frequency and to improve patients’ quality of life. Keywords: clinical trial, chronic pain, surgery, hand, preemptive analgesia, brachial plexus. / Essai cinique randomisé

Η παρουσία σοβαρού ισχαιμικού πόνου πριν από τον ακρωτηριασμό κάτω άκρου πολύ συχνά συνοδεύεται από την ανάπτυξη πόνου φάντασμα. Ερευνήσαμε αν η εντατική περιεγχειρητική αναλγησία μειώνει την ανάπτυξη πόνου φάντασμα 6 μήνες μετά τον ακρωτηριασμό. Μεθοδολογία: Σε συνολικά 65 ασθενείς πραγματοποιήθηκε προγραμματισμένος ακρωτηριασμός κάτω άκρου. Οι ασθενείς τυχαιοποιήθηκαν σε 5 ομάδες αναλγησίας: (1) Οι ασθενείς της ομάδας Επι/Επι/Επι έλαβαν περιεγχειρητικά επισκληρίδια αναλγησία και επισκληρίδιο αναισθησία; (2) Οι ασθενείς της ομάδας PCA/Επι/Επι έλαβαν προεγχειρητικά ενδοφλέβια αναλγησία ελεγχόμενη από τον ασθενή (Patient Controlled Analgesia-PCA), μετεγχειρητικά επισκληρίδιο αναλγησία και επισκηρίδιο αναισθησία; (3) Οι ασθενείς της ομάδας PCA/Επι/PCA έλαβαν περιεγχειρητικά ενδοφλέβια PCA και επισκληρίδιο αναισθησία; (4) Οι ασθενείς της ομάδας PCA/ΓΑ/PCA έλαβαν περιεγχειρητικά ενδοφλέβια PCA και γενική αναισθησία (ΓΑ); (5) Οι ασθενείς της ομάδας ελέγχου έλαβαν συμβατική αναλγησία και ΓΑ. Η επισκηρίδιος αναλγησία ή η ενδοφλέβια PCA ξεκινούσε 48 ώρες προεγχειρητικά και συνεχιζόταν για 48 ώρες μετεγχειρητικά. Τα αποτελέσματα της κλίμακας πόνου VAS (Visual Analogue Scale) και της κλίμακας πόνου McGill καταγραφόταν περιεγχειρητικά και στον 1 και 6 μήνες. Αποτελέσματα: Στους 6 μήνες, η ενδιάμεσες (median) τιμές (ελάχιστη-μέγιστη, minimum–maximum) του πόνου φάντασμα (Phantom Limb Pain – PLP) και οι τιμές P (ομάδες παρέμβασης έναντι ομάδας ελέγχου) για την κλίμακα πόνου VAS (Visual Analogue Scale) ήταν οι ακόλουθες: 0 (0–20) για την ομάδα Επι/Επι/Επι (P = 0.001), 0 (0–42) για την ομάδα PCA/Επι/Επι (P = 0.014), 20 (0–40) για την ομάδα PCA/Επι/PCA (P = 0.532), 0 (0–30) για την ομάδα PCA/ΓΑ/ PCA (P = 0.008), και 20 (0–58) για την ομάδα ελέγχου. Οι τιμές για την κλίμακα πόνου McGill (McGill Pain Questionnaire) ήταν οι ακόλουθες: 0 (0–7) για την ομάδα Επι/Επι/Επι (P = 0.001), 0 (0–9) για την ομάδα PCA/Επι/Επι (P = 0.003), 6 (0–11) για την ομάδα PCA/Επι/PCA (P = 0.208), 0 (0–9) για την ομάδα PCA/ΓΑ/PCA (P = 0.003), και 7 (0–15) για την ομάδα ελέγχου. Στους 6 μήνες πόνος φάντασμα παρουσιάστηκε σε 1 από τους 13 ασθενείς της ομάδας Επι/Επι/Επι, σε 4 από τους 13 ασθενείς της ομάδας PCA/Επι/Επι, και σε 3 από τους 13 ασθενείς της ομάδας PCA/ΓΑ/PCA έναντι 9 από τους 12 ασθενείς της ομάδας ελέγχου (P=0.001, P=0.027, και P=0.009, αντίστοιχα). Ο πόνος κολοβώματος στους 6 μήνες ήταν ασήμαντος. Συμπεράσματα: Η χρήση εντατικήςς αναλγησίας, με χρήση επισκληριδίου ή ενδοφλέβιας PCA, η οποία ξεκινάει 48 ώρες προεγχειρητικά και συνεχίζεται για 48 ώρες μετεγχειρητικά, μειώνει τον πόνο φάντασμα στους 6 μήνες. Trial registration: Clinical Trials.gov, number NCT00443404 / Severe preamputation pain is associated with phantom limb pain (PLP) development in limb amputees. We investigated whether optimized perioperative analgesia reduces PLP at 6-month follow-up. Methods: A total of 65 patients underwent lower-limb amputation and were assigned to five analgesic regimens: (1) Epi/Epi/Epi patients received perioperative epidural analgesia and epidural anesthesia; (2) PCA/Epi/Epi patients received preoperative intravenous patient-controlled analgesia (PCA), postoperative epidural analgesia, and epidural anesthesia; (3) PCA/Epi/PCA patients received perioperative intravenous PCA and epidural anesthesia; (4) PCA/GA/PCA patients received perioperative intravenous PCA and general anesthesia (GA); (5) controls received conventional analgesia and GA. Epidural analgesia or intravenous PCA started 48 h preoperatively and continued 48 h postoperatively. The results of the visual analog scale and the McGill Pain Questionnaire were recorded perioperatively and at 1 and 6 months. Results: At 6 months, median (minimum–maximum) PLP and P values (intervention groups vs. control group) for the visual analog scale were as follows: 0 (0–20) for Epi/Epi/Epi (P _ 0.001), 0 (0–42) for PCA/Epi/Epi (P = 0.014), 20 (0–40) for PCA/Epi/PCA (P = 0.532), 0 (0–30) for PCA/GA/ PCA (P = 0.008), and 20 (0–58) for controls. The values for the McGill Pain Questionnaire were as follows: 0 (0–7) for Epi/Epi/Epi (P = 0.001), 0 (0–9) for PCA/Epi/Epi (P = 0.003), 6 (0–11) for PCA/Epi/PCA (P = 0.208), 0 (0–9) for PCA/GA/PCA (P = 0.003), and 7 (0–15) for controls. At 6 months, PLP was present in 1 of 13 Epi/Epi/Epi, 4 of 13 PCA/Epi/Epi, and 3 of 13 PCA/GA/PCA patients versus 9 of 12 control patients (P=0.001, P=0.027, and P=0.009, respectively). Residual limb pain at 6 months was insignificant. Conclusions: Optimized epidural analgesia or intravenous PCA, starting 48 h preoperatively and continuing for 48 h postoperatively, decreases PLP at 6 months. Trial registration: Clinical Trials.gov, number NCT00443404