Orientador: Stelio Pacca Loureiro Luna / Coorientador: Jackson Barros do Amaral / Banca: Celso Antonio Rodrigues / Banca: Paulo Sérgio Patto dos Santos / Banca: Marilda Onghero Taffarel / Banca: Silvia Elaine Rodolfo de Sá Lorena / Resumo: A dor tem sido historicamente negligenciada em animais e o seu reconhecimento e quantificação ainda são um desafio a ser superado, sobretudo em animais de grande porte. Objetivou-se registrar os comportamentos e definir a validade e confiabilidade de uma escala para avaliar a dor aguda pós-operatória em bovinos. Quarenta bovinos foram submetidos à orquiectomia com sedação e anestesia local. Os animais foram avaliados e filmados, antes e após o procedimento cirúrgico e a partir da análise dos vídeos foi desenvolvido um registro de comportamentos. Adicionalmente foi utilizado um pedômetro adaptado ao membro do animal, para informações do número de passos, tempo em decúbito e número de vezes que entra em decúbito, no sentido de correlacionar ou não com as experiências de dor no período pós-operatório. A escala se baseou em estudos prévios, estudo piloto e análise das filmagens. Avaliaram-se os animais por meio de filmes referentes aos períodos pré-operatório (M1) e pós-operatório, antes (M2) e após analgesia de resgate (M3) e 24 horas após a cirurgia (M4). Três observadores encobertos e um padrão-ouro avaliaram os filmes e estes foram reavaliados um mês após a primeira análise pelos observadores encobertos. Observou-se diferença no número de vezes que entra em decúbito entre 24 horas antes e após o procedimento cirúrgico. O refinamento da escala foi determinado pela validade do critério atestada pela concordância entre os observadores encobertos e o padrão-ouro, de forma que os itens postura em estação e posição da cabeça foram excluídos da escala por não apresentarem concordância satisfatória. Realizou-se a análise fatorial para determinar a dimensionalidade da escala, resultando em uma escala unidimensional. A correlação item-total pelo coeficiente de correlação de Spearman determinou a exclusão do item atenção à ferida cirúrgica. Após o refinamento, a consistência interna foi ... / Abstract: Pain has been historically neglected in animals and its recognition and quantification remains a challenge to be overcome, especially in large animals. This study aimed to record behaviors and define the validity and reliability of an acute postoperative pain scale in cattle. Forty cattle underwent orchiectomy with sedation and local anesthesia. Animals were evaluated and filmed before and after the surgical procedure. The videos were viewed and behaviors were recorded. Additionally, a pedometer was adapted on the limb of each animal to record the number of steps, time of lying down and number of times to get decubitus. These data were used to correlate or not with the experience of pain in the postoperative period. The scale was based on previous studies, pilot study and video records analysis. Animals were evaluated by movies in preoperative (M1) and postoperatively period, before (M2) and after rescue analgesia (M3) and 24 hours after surgery (M4). Three blinded and one gold standard observers evaluated the movies, which were revalued one month after the first analysis. Difference in the number of times to get decubitus between 24 hours before and after the surgical procedure was detected. The refinement of the scale was determined by criterion validity. This was attested by agreement between each blinded observers and the gold standard, so the items standing posture and head position were excluded for not having satisfactory agreement. Factor analysis determined the dimensionality of the scale, resulting in a unidimensional scale. Item-total correlation by Spearman rank correlation coefficient determined the exclusion of the item attention to surgical wound. After refinement, internal consistency was assessed by calculating the Cronbach α coefficient (α = 0.866) and was considered excellent. UNESP-Botucatu unidimensional pain scale was correlated with visual analogic, descriptive and numerical ... / Doutor

The aim of our study was to assess the changes of free radicals and other biochemical parameters after nociceptive stimulation in different experimental animal models. In patiens we detected whether preemptive analgesia had a positive effect on acute postoperative pain. Objective evaluation of pain intensity is a long-term problem because the objectification of using electrophysiological and imaging methods is currently difficult and expensive, and therefore in laboratories in the Czech Republic and many other places are used the evaluation by means biochemical methods. We implemented large experimental studies using mechanical, inflammatory and visceral nociception and we found out in particular that nitroxid and hydroxyl free radicals and singlet oxygen increased significantly after nociceptive stimulation. This increase can be suppressed by antioxidants. At the same time, we showed that some parameters of metabolism lipids, carbohydrates and proteins have also been changed. In particular, we measured the free hydroxyl radicals and singlet oxygen by EPR method in the tail of living and anesthetized rats. This method is absolutely a priority and has never been used before. Earlier experimental results were partially clinically verified using different types of acute and chronic pain in humans...

Com o desenvolvimento tecnológico, cada vez mais, os neonatos têm sido expostos a procedimentos dolorosos. Atualmente, existem várias intervenções farmacológicas e não farmacológicas para o alívio da dor. Há escassez de estudos sobre a a exposição à dor dos recém-nascidos e as práticas para o seu manejo nas unidades neonatais brasileiras. Este estudo descritivo exploratório teve como objetivo dimensionar a exposição a procedimentos dolorosos de recém-nascidos pré-termo e as intervenções farmacológicas e não farmacológicas utilizadas para o alívio da dor, durante os primeiros 14 dias de vida em unidades neonatais de um hospital universitário de Ribeirão Preto - SP. Participaram do estudo 89 prematuros, após obtenção do consentimento livre e esclarecido dos responsáveis. Foi adicionado um questionário no prontuário dos neonatos para registro dos procedimentos dolorosos, intervenção analgésica, número de tentativas e profissional que realizou o procedimento. A coleta de dados foi realizada no período de outubro de 2012 a outubro de 2013. Também foi realizada busca nos prontuários dos prematuros para minimizar falha de registro e completar questionários que se encontravam incompletos. Realizada dupla digitação dos dados no Excel e para análise estatística foi utilizado o SPSS. Na análise quantitativa dos dados utilizou-se a estatística descritiva e para comparação das médias de distribuição dos procedimentos dolorosos foi testada a normalidade por meio do teste Kolmogorov-Smirnov (?=0,05), e uso de estatística paramétrica para amostras independentes e estatística paramétrica para amostras dependentes, comparando as médias de procedimentos dolorosos segundo os grupos das variáveis peso ao nascer e idade gestacional com uso do teste ANOVA oneway (?=0,05); para as variáveis sexo e uso de ventilação invasiva utilizou-se o teste t-student não pareado (?=0,05) e para a variável período de internação utilizou-se o teste t-student para duas amostras em par (?=0,05). Obtiveram-se seguintes resultados: média de peso de 1384,1 ± 615,7g; média de idade gestacional de 30,6 ± 3,1 semanas; escore de risco SNAPPE II de 25,8 ± 20,2; parto cesáreo mais frequente (65,2%); média de tempo do uso de ventilação invasiva de 5,9 ± 5,5 dias; média total do tempo de internação 56,1 ± 50,4 dias. Foram realizados 6.687 procedimentos dolorosos, 65,5% registrados no questionário e 34,5% inseridos a partir do levantamento dos prontuários. A média diária foi de 5,37 procedimentos dolorosos por prematuro; na primeira e segunda semanas de internação as médias foram de 6,56 e 4,18 procedimentos dolorosos diários por prematuro (p<0,0001). Os procedimentos mais frequentes foram as aspirações nasal ou oral (35,85%) e traqueal (17,17%). Os prematuros que ficaram em ventilação invasiva foram os mais expostos a procedimentos dolorosos (71,2%). Apenas 44,9% dos procedimentos dolorosos tiveram alguma intervenção para o alívio da dor, sendo mais utilizada a sacarose (78,21%) e analgesia contínua (19,82%). Constata-se o subtratamento da dor aguda nessas unidades neonatais, recomendando-se maior sensibilização da equipe para o uso efetivo do protocolo existente e a implantação de outros para o manejo adequado e alívio da dor dos recém-nascidos / Due to technological development, neonates are increasingly exposed to painful procedures. Currently, there are many pharmacological and non-pharmacological interventions to relieve pain. Few studies address the exposure of newborns to pain and practices used to manage pain in Brazilian neonatal units. This exploratory descriptive study aimed to verify exposure of preterm newborns to painful procedures and pharmacological and non-pharmacological interventions used to relieve pain in the first 14 days of life in neonatal units of a university hospital in Ribeirão Preto, SP, Brazil. A total of 89 preterm infants participated in the study after their legal guardians signed free and informed consent forms. A questionnaire was added to the neonates\' medical files to record painful procedures, analgesic interventions, number of attempts, and the professional who performed the procedure. Data were collected from October 2012 to October 2013. The infants\' medical files were checked to minimize missing information and incomplete questionnaires. Data were double entered in Excel and SPSS was used for the statistical analysis. Descriptive statistics was used for the quantitative analysis and the Kolmogorov-Smirnov test (?=0.05) was employed to verify normality in order to compare the means of distribution of painful procedures. Parametric statistics was used for both independent and dependent samples. The means of painful procedures were compared according to groups of variables: for birth weight and gestational age one-way ANOVA (?=0.05) was used; t- student test (?=0.05) was used for sex and use of invasive ventilation; and finally, two sample matched t-student (?=0.05) was used for the variable period of hospitalization. The results indicated average weight of 1,384.1 ± 615.7g; average gestational age of 30.6 ± 3.1 weeks; SNAPPE II risk score of 25.8 ± 20.2; C-sections were more frequent (65.2%); average time invasive ventilation was used was 5.9 ± 5.5 days; and total average of length of hospitalization of 56.1 ± 50.4 days. A total of 6,687 painful procedures were verified: 65.5% was recorded in the questionnaire and 34.5% was included after checking the medical files. The daily average of painful procedures per infant was 5.37; the averages of daily painful procedures per infant in the first and second weeks of hospitalization were 6.56 and 4.18 (p<0.0001) respectively. The most frequent procedures were nasal or oral (35.85%) and tracheal (17.17%) aspirations. The infants receiving invasive ventilations were the ones most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures included some pain relief intervention and the most used were sucrose (78.21%) and continuous analgesia (19.82%). Under treatment of acute pain was observed in the neonatal units and greater sensitization of the staff for effectively using the existent protocol and implementing other measures to appropriately manage and relieve pain among newborns is recommended

nÃo hà / O estudo tem por objetivo revisar o diagnÃstico de enfermagem (DE) Dor aguda em pacientes hospitalizados com infarto agudo do miocÃrdio (IAM). Estudo metodolÃgico de validaÃÃo de diagnÃsticos de enfermagem, desenvolvido em trÃs etapas fundamentadas no modelo de Hoskins (1989): anÃlise de conceito de dor aguda, validaÃÃo por especialistas e validaÃÃo clÃnica. Na primeira etapa utilizaram-se o modelo de Walker e Avant (2005) e a revisÃo integrativa conforme Whittemore; Knafl (2005) a partir da busca em periÃdicos indexados, por meio do acesso nas bases de dados CINHAL, SCOPUS e PUBMED, de estudos publicados sobre dor aguda no infarto agudo do miocÃrdio no perÃodo de 2006 a 2012. Para a busca nas bases de dados utilizou-se o vocabulÃrio MeSH â Medical Subject Headings of U.S National Library of Medicine e o DeCS â Descritores em CiÃncias da SaÃde em lÃngua inglesa e espanhola: acute pain; myocardial infarction e dolor agudo, el infarto miocardio. Para a busca nas trÃs bases de dados e cruzamento dos descritores utilizou-se o operador booliano âANDâ. Para ampliar a busca empregou-se o cruzamento: âacute painâ and âmyocardial infarctionâ. Aplicados os critÃrios de inclusÃo e exclusÃo, restaram 29 estudos. Encontraram-se quatro atributos crÃticos essenciais para a compreensÃo do conceito dor aguda no infarto agudo do miocÃrdio: qualidade (constrictiva, opressiva, pressÃo, aperto e peso, sensaÃÃo de esmagamento, tÃpica isquÃmica, dilacerante e triturante); localizaÃÃo (regiÃo retroesternal, subesternal, torÃcica, do lado esquerdo do peito, centro do esterno emeio do peito, peito direito); tempo e duraÃÃo (inÃcio sÃbito, prolongada com duraÃÃo de 15 a 30 minutos, recorrente e intermitente); irradiaÃÃo (pescoÃo, ombro esquerdo, mandÃbula, regiÃo interescapular, braÃo direito e esquerdo, costas, estÃmago, abdome, epigastro, pulso braquial e radial esquerdo). Foram identificadas 14 caracterÃsticas definidoras(CDs) na anÃlise de conceito, das quais oito encontraram correspondÃncia no DE Dor aguda da NANDA-I. Elaborou-se um instrumento com a definiÃÃo construÃda na anÃlise de conceito, a constante na NANDA-I e as 14 CDs e respectivas definiÃÃes conceituais e referÃncias empÃricas identificadas. Submeteu-se esse instrumento ao crivo de 22 especialistas em terminologias de enfermagem e/ou dor aguda e/ou infarto agudo do miocÃrdio. Dos especialistas (54,54%) optaram pela definiÃÃo resultante da anÃlise de conceito. ApÃs o julgamento, recomenda-se, alÃm das oito CDs identificadas na NANDA-I, o acrÃscimo de mais seis CDs ao DE Dor aguda identificadas na anÃlise de conceito: Dispneia; Fraqueza; Fadiga; NÃusea; VÃmito e Palidez. As 14 CDs analisadas e validadas por especialistas foram testadas na prÃtica clÃnica, por meio de um estudo transversal realizado com 125 pacientes com diagnÃstico de IAM. Os achados mostraram que Relato de dor aguda, Diaforese, Fadiga, Palidez e Fraqueza, sÃo bons indicadores da ocorrÃncia do diagnÃstico de enfermagem Dor aguda no infarto agudo do miocÃrdio. As CDs PressÃo sanguÃnea elevada, DistÃrbio do sono, FrequÃncia cardÃaca elevada, FrequÃncia respiratÃria elevada, DispnÃia, NÃusea, VÃmito, Ansiedade e Medo nÃo foram indicadores satisfatÃrios do diagnÃstico em estudo. Portanto, cinco CDs demonstraram-se conforme a anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica, apropriadas para avaliar o DE Dor aguda em pacientes com IAM. / The objective of the study was the nursing diagnosis validation (ND) of Acute Pain of patient with Acute Myocardial Infarction (AMI). Methodological study developed in three stages of nursing diagnosis validation, found by the Hoskins model (1989): concept analysis, validation by specialists and clinical validation. In the first stage were Walker and Avant model (2005) and Whittemore; Knafl (2005) integrative review from the indexed journal search by the CINHAL, SCOPUS and PUBMED database access of studies published in the period between 2006 and 2012. The Pubmed and Cinahl database search used the indicated terminology, the MeSH â Medical Subject Headings of U.S National Library of Medicine English vocabulary. The Scopus database had DeCS â Descriptors Health Science structure vocabulary. To identify the different uses of acute concept, there was a study survey with the controlled descriptors Acute Pain and Myocardial Infarction in English language and Dolor Agudo and Infarto Miocardio in Spanish language. In the three databases search descriptorÂs crossing we used the Boolean operator âANDâ. âAcute painâ and âmyocardial infarctionâ enlarge the crossing search. After applying the exclusion and inclusion criteria, 29 studies remained (from 535). There were four essential critical characteristics to understand acute pain concept. They are quality (constrictive, oppressive, pressure, tightness and weight, crushing feeling, typical ischemic, heartbreaking and grinding); location (retrosternal region, substernal, chest, the left side of the chest, sternum and through the center of the chest, right chest); time length (sudden onset, prolonged lasting 15 to 30 minutes, recurrent and intermittent); irradiation (neck, left shoulder, jaw, interscapular region, right and left arm, back, stomach, abdomen, epigastrium, left radial and brachial pulse). For the Acute Pain ND, NANDA-I presents 18 defined characteristics (DCs) identifying eight in the concept analysis adequate for Acute Pain diagnosis in AMI patients. Besides these ones, we found six more, in 15 DCs. There were elaboration of an instrument with the concept analysis definition, the constant NANDA-I and 14 DCs and their conceptual definitions and identified empiric references. Twenty-two specialists studied this instrument in nursing terminology and/or acute pain and/or acute myocardial infarction. From them (54,54%) they opted concept analysis definition. After appreciation, there were recommendation of the eight DCs identified in the NANDA-I and six new DCs for the ND Acute pain identified in the concept analysis. They were dyspnea; weakness; fatigue; nausea; Vomiting and paleness. The specialist tested in the clinical practice the 14 analyzed and validated DCs, through a transversal study done with 125 patients with AMI diagnosis. The findings showed that the acute pain, Diaphoresis, Fatigue, Paleness and Weakness are good indicators of the Acute Pain nursing diagnosis. The Elevated Blood Pressure, Sleep Disturbance, Elevated Heart Rate, Elevated Respiratory Rate, Dyspnea, Nausea, Vomiting, Anxiety and Fear DCs, were not satisfactory indicators of the study diagnosis. Therefore, five DCs were according to concept analysis, specialist validation and clinical validation, right to evaluate the Acute Pain ND in AMI patients.

A dor aguda pós-operatória tem suscitado grande interesse por seu potencial risco de cronicidade caso não seja adequadamente tratada, podendo piorar a recuperação e a qualidade de vida do paciente. Este estudo comparativo foi realizado de maneira prospectiva, aleatória e encoberta para se avaliar os efeitos sedativos, analgésicos e na resposta inflamatória da administração de metadona ou tramadol. Foram incluídos 28 cães com ruptura de ligamento cruzado e submetidos a osteotomias corretivas, distribuídos em três grupos: TRA - 4 mg/kg de tramadol; MET0,5 - 0,5 mg/kg de metadona e MET0,7 - 0,7 mg/kg de metadona, administrados por via intramuscular na medicação pré-anestésica (MPA). A indução da anestesia foi realizada com propofol e os animais foram intubados e mantidos com isofluorano em oxigênio a 100%. Parâmetros fisiológicos (frequências cardíaca, respiratória e pressão arterial) foram avaliados nos dados momentos: TBL (basal), T1 (uma hora após a MPA), T2 (duas horas após, transcirúrgico), T4 (quatro horas após, pós-cirúrgico), T6 (seis horas após) e T24 (24 horas após). Escores de sedação e dor foram avaliados por escalas em TBL, T1, T4, T6 e T24. Coletas de sangue para mensuração de IL-6 foram realizadas em TBL, T1, T6 e T24. Animais apresentando escores na escala análoga visual maiores que 4, na escala de Glasgow maiores que 5 ou na escala de Colorado maiores que 2, recebiam analgesia complementar com o fármaco do grupo em que foram alocados. Utilizou-se análise de variância para medidas repetidas (ANOVA) com pós teste de Tukey para análise estatística dos parâmetros fisiológicos. Escores de dor e sedação foram comparados entre diferentes momentos por teste de Friedman, seguido de teste de Tukey. Os grupos foram comparados em um mesmo momento, por teste não-paramétrico Kruskal-Wallis, seguido de teste post hoc de Dunn. Valores de p<0,05 expressam diferença significativa. Não houve diferença entre os grupos com relação a idade, peso e sexo, além de tempos de cirurgia e extubação. Os valores de frequência cardíaca, respiratória e pressão arterial mantiveram-se dentro dos parâmetros aceitáveis nas condições avaliadas, havendo redução nos valores em T2 nos grupos MET0,5 e MET 0,7 com relação ao TBL. Para os escores na escala análoga visual, dentro do grupo TRA houve aumento significativo em T4 comparado a TBL, T1 e T24 e entre T1 e T6 (p<0,001). No grupo MET0,5, houve aumento significativo de T1 para T4 (p<0,001). Os grupos TRA e MET0,5 apresentaram médias±DP mais altas (3,4±2,5 e 2,5±2,6, respectivamente) que MET0,7 (1,1±1,5) em T4. Na escala de dor de Glasgow, em MET0,5, houve aumento significativo no momento T4 com relação aos momentos T6 e T24 (p<0,001). No grupo MET0,7, houve aumento significativo no momento T4 para TBL e T24 (p<0,001). Houve maior necessidade de resgate no grupo TRA (quatro animais em T4 e dois em T6), contudo após um incremento na dose do fármaco, obteve-se controle adequado da dor. Não foram observadas diferenças estatísticas significativas quanto ao grau de sedação, escala de Colorado e interleucinas séricas entre os grupos e momentos avaliados. A metadona e o tramadol foram eficazes em promover analgesia pós-operatória quando administrados antes do procedimento cirúrgico e suas doses ajustadas no resgate analgésico. Ambos parecem ter tido efeito sobre a liberação de IL-6, sugerindo modulação da resposta inflamatória aguda / Acute postoperative pain has aroused great interest because of their potential risk of chronification if not treated properly, may worsen the recovery and quality of life of the patient. This clinical trial was conducted in a prospective, randomized, double-blind comparison to evaluate the efficacy of methadone and tramadol as premedication in dogs. 28 animals with ruptured cruciate ligament undergoing corrective osteotomies were divided into three groups: TRA - received 4 mg/kg of tramadol; MET0.5 - received 0.5 mg/kg of methadone and MET0.7 - received 0.7 mg/kg of methadone intramuscularly. Anesthesia induction was performed with propofol and animals intubated for general anesthesia with isoflurane in 100% oxygen. Physiological parameters (heart and respiratory rate and blood pressure) were evaluated at specified times (in hours): TBL (baseline), T1, T2, T4, T6 and T24. Pain and sedation scores were described by use of visual analogue scale (VAS), composite modified Glasgow scale and Colorado scale at TBL, T1, T4, T6 and T24. Blood samples for measurement of IL-6 were performed in moments TBL, T1, T6 and T24. Statistical analysis was performed by ANOVA for repeated measurements. Pain and sedation scores were compared in different times by Friedman\'s test followed by Tukey test. Groups were compared by non-parametric Kruskal-Wallis test followed by post hoc Dunn\'s test. Values with p <0.05 were considered significant. There was no statistically significant difference among groups with respect to age, weight, gender, time of surgery and time for extubation. Heart rate, respiratory rate and blood pressure values were maintained within acceptable values and a reduction was observed in T2 in groups MET0.5 and MET0.7 in relation to TBL. Increases in VAS scores were observed in TRA in T4 compared to TBL, T1 and T24 and between T1 and T6 (p<0.001). In MET0.5 there was a significant increase in T4 when compared to T1 (p<0.001). Groups TRA and MET0.5 showed higher mean±SD values (3.4±2.5 and 2.5±2.6, respectively) than MET0.7 (1.1±1.5) in T4. In Glasgow pains scale, there was significant increase in T4 when compared to T6 and T24 (p<0.001). In MET0.7, T4 showed higher scores than TBL and T24 (p<0.001). TRA showed greater demand of rescue analgesia (four animals in T4 and two in T6), however after a dose adjustment pain was controlled. There were no statistically significant differences in degree of sedation, Colorado acute pain scale and serum interleukin among groups and time points assessed. Both drugs were effective in promoting postoperative analgesia when administered prior to surgical procedure and the doses adjusted according to demand. The drugs appear to have an effect on the release of IL-6, suggesting acute inflammatory response modulation

A fisioterapia é uma área medicina veterinária com um crescente interesse científico, da mesma forma que sua aplicação em pequenos animais. Em cães, entre as indicações da reabilitação está o pós-operatório ortopédico recente, em que os objetivos principais são o controle álgico e da inflamação, possibilitando um restabelecimento funcional precoce. Dentre as afecções ortopédicas, a ruptura de ligamento cruzado cranial é a mais comum na articulação fêmoro-tíbio-patelar em cães, sendo a técnica de nivelamento do platô tibial amplamente empregada. O presente estudo teve como objetivo a análise dos efeitos da eletroterapia e da laserterapia nos aspectos de dor e inflamação no pós-operatório recente da referida cirurgia ortopédica. Para esta avaliação, foi utilizada uma metodologia multimodal que incluiu escalas de dor unidimensional (ENV) e multidimensional (Glasgow), escalas de claudicação, análise cinética por baropodometria, análises perimétricas e termográficas da articulação. Vinte e quatro cães foram selecionados, sendo que efetivamente distribuídos e randomizados entre os grupos, 16. Dentre eles, 9 animais foram distribuídos no grupo Fisioterapia (F) e 7 no grupo Placebo(P). Os animais do grupo fisioterapia foram submetidos a 6 sessões de eletroterapia associada à laserterapia, enquanto os animais do segundo grupo submetidos a 6 sessões placebo. Ambos os grupos foram avaliados antes da cirurgia, no pós-operatório previamente às sessões e ao término das 6 sessões. O grupo fisioterapia teve benefícios evidenciados nas análises seriadas das escalas de dor, com valores de P=0,0156 e P=0,011, nos quesitos de ENV do avaliador e do cuidador respectivamente. Nas análises de dor através da escala de Glasgow, os valores de P=0.0272 na análise seriada do grupo tratado, confirmando a melhora deste grupo em relação ao controle, onde o resultado de P=0.4375. Porém, não foram observadas diferenças nos quesitos de escalas de claudicação, avaliação de edema através de perimetria, e, inflamação através da termografia, em relação ao grupo placebo. Na avaliação cinética, houve diferença na análise dos parâmetros de impulso vertical, tendendo à melhora do grupo fisioterapia, porém na análise do pico de força vertical, que é mais sensível, não houve diferença entre os grupos. Houve também a necessidade de resgate analgésico em três animais do grupo placebo, sendo que nenhum animal do grupo Fisioterapia necessitou de resgate. Conclui-se que os animais submetidos às sessões de fisioterapia tiveram melhor evolução nos quesitos de dor, além de não necessitarem de resgate analgésico. Não houve influência da laserterapia no controle da inflamação e do edema através dos métodos avaliados. Evidencia-se a necessidade de mais estudos sobre os resultados das técnicas de fisioterapia quando aplicadas à rotina clínica veterinária, especialmente, com um maior número de amostras / Physical therapy is a veterinary medicine area with a growing scientific interest, as its application in small animals. In dogs, among the physiotherapy indications is the recent orthopedic post operatory period, in order to control pain and inflammation to get an early functional recovery. Among the orthopedic diseases, the cranial cruciate ligament rupture is the most common disease in the femoral-tibio-patellar joint in dogs, and the tibial plateau leveling osteotomy, the to more common surgical approach. This study aimed to evidence the effects of electrotherapy and laser therapy on aspects of pain and inflammation in the post operatory of that recent surgery. For this evaluation were used multimodal methods that included unidirectional and multidirectional pain scales, lameness scales, kinetic analysis by baropodometry, perimeter and thermographic analysis. Twenty-four dogs were selected, which effectively distributed between the groups 16. Among them, 9 animals in physiotherapy group (F) 7 and the placebo group (P). Animals in the physical therapy group underwent 6 electrotherapy sessions associated with laser therapy, and the other group underwent 6 placebo sessions. Both groups were evaluated before surgery, in the post recent post operatory, before the treatment, and after 6 sessions. The physiotherapy group had benefits shown in the serial analysis of pain scales, with P = 0.0156 and P = 0.011 values for the treated group, for ENV questions of the evaluator and the owner, respectively. The pain analysis by the Glasgow scale, the values of P = 0.0272 in the serial analysis of the treated group, confirming the improvement of this group compared to the control group, which had the P = 0.4375. Despite of these findings, no differences were observed in the categories of lameness scales, edema assessment through perimetry and thermography. In the kinetic evaluation, there were differences in the analysis of vertical impulse parameters, tending to improve of the physiotherapy group, but in the analysis of vertical peak force, which is more sensitive, there was no difference between groups. There was also the need for analgesic rescue medication in three animals of the placebo group. We conclude that animals subjected to actual physical therapy sessions had improvement in pain scores, and do not require analgesic rescue. There was no influence on the swelling or on the inflammation through the methods used in this study. Further studies are needed, especially with a larger number of animals

Background Measuring pain in infants is important but challenging for researchers and health care professionals. The measurement of skin conductance (SC) is considered as a measure of stress and a surrogate indicator of pain. Purpose This dissertation provides insight on the validity of SC for pain measurement in infants and consists of two studies: 1) a scoping review synthesizing the methods and findings of previous studies on validating or using SC for measuring pain in infants; 2) a primary study evaluating the validity of SC for measuring pain in mechanically ventilated infants. Methods Arksey and O’Malley’s framework informed the methods of the scoping review. Nine electronic databases were searched. Data were analyzed and presented descriptively. The primary study used a prospective cross-sectional observational design. Eligible infants were those up to 12 months of age, hospitalized in intensive care units, who were mechanically ventilated, and required painful and non-painful procedures. Results Scoping review: Twenty-eight studies with 1061 infants were included, including 23 cross-sectional observation studies and five interventional studies. The validity evidence of SC was tested in relation to referent pain measures (13 variables), stimuli (13 variables), age (2 variables) and other contextual variables (11 variables). Fifteen studies evaluated the validity evidence in relation to phase of painful procedure, and SC increased significantly during painful procedures in most studies (n=14/15). However, inconsistent findings on other validity evidence and wide variation in methods existed across studies. Primary study: SC showed good validity in relation to the category of procedure, the phase of procedure and the referent pain measures in critically ill mechanically ventilated infants. The findings from diagnostic test accuracy showed that SC had good capacity of detecting moderate to severe pain. However, the values of SC need to be used with caution, due to the imperfect correlations with the referent pain measures and imperfect positive predictive value. Conclusions SC is a promising approach to measuring pain in critically ill infants. Further research testing the validity of SC in relation to pain treatments and advancing the technology of measuring and analyzing SC is needed before it can be recommended for clinical use.

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.

Bakgrund: Den goda vården syftar till att lindra mänskligt lidande, såsom smärta. Detta är inte alltid uppnått inom den slutna sjukvården idag, och patientens smärta blir inte lindrad. Musik kan användas som en hälsointervention inom sjukvården och har visats ha en rad positiv inverkan på patienten. Syfte: Beskriva vad musiken som en individanpassad omvårdnadshandling har för verkan på patientens smärttillstånd vid en akut smärta.Metod: En litteraturstudie baserad på 14 utvalda kvantitativa studier om musikens verkan på ett akut smärttillstånd. Resultat: Resultatet visar på att musik som en individanpassad omvårdnadshandling kan lindra patientens smärttillstånd. Musiken har en viss möjlighet att minska den subjektiva upplevelsen av smärttillståndet, såsom upplevelsen av ångest och smärta. Likväl kan fysiska parametrar under smärttillståndet, såsom blodtryck och andningsfrekvens också påverkas av musiken. Musiken kan också ge en ökad grad av avslappning till patienten. Slutsats: Under ett akut smärttillstånd har musiken visats verka på hela den mångdimensionella människan, både på kropp och på psyke. Genom musiken har sjuksköterskan ett redskap som utifrån ett helhetsperspektiv kan lindra patientens lidande. / Background: Good care has for aim to relieve human suffering, such as pain. This is not always achieved in the hospital care, and patients' pain isnot relieved totally. Music could be used as an intervention to improve health in hospital setting and has been shownto have a positive effect on the patient. Aim:To describe what the effect of music, as an individual nursing intervention, has on the patients's acute pain. Method:A literature review,based on 14 selectedquantitative studies, regarding the effect of music on a state of acute pain, was done. Results:The results show that music, as an individual nursing intervention, can help patients to reduce their acute state of pain. The music can possibly have a reducing effect on the subjective experience of the state of pain such as the experience of anxiety and pain. Music can also have aneffect on the vitalsigns, such as blood pressure and respiratory rate. The music can also provide an increased degree of relaxation. Conclusion:During a state of acute pain music has shown effecton the whole multidimensional human, both body and spirit. Through music the nurse is given a tool that from a holistic perspective can relieve patient suffering.

Pain is the universal symptom of illness and trauma. It affects people of all ages, cultures, and backgrounds, causing distress and suffering. Appearing in a plethora of diagnoses, almost all patients will experience some type of pain as a related symptom during their lifetime. The ubiquitous nature of pain renders it likely that a wide variety of healthcare providers will treat patients reporting pain in both the acute care and longitudinal settings. Many institutions and governing bodies in the medical sphere have emphasized the duty of the medical field to treat pain and thereby alleviate suffering. It is common for Emergency Medicine (EM) physicians to manage patients presenting to the Emergency Department (ED) in pain. Although these patients’ etiologies for their pain may differ, most will be experiencing pain from an acute insult. Emergency Medical Services (EMS) is the extension of EM into the prehospital setting. As such, EMS providers interact with many of the same patients experiencing acute pain. Despite the prevalence of pain and the importance of alleviating it, acute pain management has often been inadequate. Improving pain management should continue to be a high priority. Opioid analgesics have long been the standard of care for acute pain management. The first opiate, morphine, was isolated in the early 1800’s. Opioids are potent analgesics and are titratable to effect. However, they have a significant adverse effect profile. Among other adverse effects, opioids can cause hypotension and respiratory depression. In addition, the United States opioid epidemic has placed increased pressures on EMS and the entire healthcare profession to utilize opioid alternatives while continuing to improve the quality of acute pain management provided to patients. As a result, non-opioid analgesics have gained increased attention and use in EMS. They generally have fewer adverse effects than opioids and are not typically associated with a potential for addiction and abuse. However, the individual and subjective nature of the pain experience increases the difficulty of achieving improved analgesia. EMS providers must weigh these various factors and the complexity of the pain experience when determining the most appropriate treatment for acute pain. This review seeks to determine if non-opioid analgesics have potential for use as first line treatment by EMS over opioid analgesics, the standard of care for acute pain management. The purpose of this review of the current literature, especially comparison studies, is to investigate the common EMS analgesics: morphine, fentanyl, acetaminophen, ketorolac, ibuprofen, nitrous oxide, methoxyflurane, and ketamine. The findings are discussed in relation to four important outcome measures identified: effect on pain severity, rescue analgesic use, patient satisfaction, and the consideration of risks. Due to the paucity of research on this important topic, a general recommendation cannot be made for the use of non-opioid analgesics as first line treatment for acute pain management by EMS. However, this review provides several specific suggestions regarding the use of non-opioid analgesics as first line treatment by EMS. Applicability concerns are addressed, and a protocol is presented that EMS could use to adapt the findings to existing protocols.