Orientador: Angelica de F. de Assunção Braga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T23:53:56Z (GMT). No. of bitstreams: 1 Loyola_YolandaChristinadeSousa_D.pdf: 22412843 bytes, checksum: 64766635e73a046988de0b090a234fe6 (MD5) Previous issue date: 2006 / Resumo: Os anestésicos locais comumente empregados na prática clínica podem interagir com os bloqueadores neuromusculares e potencializar seus efeitos. Muitos autores estudaram esta interação mas o mecanismo envolvido na potencialização do bloqueio neuromuscular e a ação dos anestésicos locais nos sítios pré e pós juncionais não foram completamente elucidados. Neste trabalho através de experimentos específicos na junção neuromuscular foram estudados os seguintes parâmetros: o efeito dos anestésicos locais procaína e lidocaína na transmissão neuromuscular; a sua influência no bloqueio neuromuscular produzido pela d-tubocurarina e pelo rocurônio; a eficácia da neostigmina e da 4-aminopirídina na reversão do bloqueio produzido pela associação anestésicos locais - bloqueadores neuromusculares; os efeitos dos anestésicos locais nos potenciais de membrana e potenciais de placa terminal em miniatura. Avaliou-se também em preparações diafragma de rato cronicamente desnervado e biventer cervicis de pintainho os efeitos dos anestésicos locais na ação contraturante da acetilcolina. Os resultados foram expressos em médias e desvios padrão e analisados através dos testes de Wilcoxon e Mann-Witney, adotando-se um nível de significância de 5% (p < 0,05). Nas preparações nervo frênico - diafragma de rato, sob estimulação elétrica indireta, os anestésicos locais nas concentrações empregadas, não alteraram a amplitude das respostas musculares mas potencializaram os efeitos da d- tubocurarina e do rocurônio.. Este bloqueio foi parcialmente e totalmente revertido pela neostigmina e pela 4-aminopiridina, respectivamente. A procaína e a lidocaína não causaram alteração significativa nos potenciais de membrana, não demonstrando ação despolarizante na fibra muscular. A procaína causou diminuição na amplitude e na freqüência dos potenciais de placa terminal em miniatura (pptms) e a lidocaína, ao contrário, promoveu um aumento inicial na freqüência dos pptms seguida de bloqueio. Nas preparações biventer cervicis de pintainho e diafragma de rato cronicamente desnervado, a procaína e a lidocaína promoveram diminuição significativa na resposta contraturante da acetilcolina evidenciando um efeito pós-juncional. Os resultados obtidos demonstram um sinergismo entre as drogas devido principalmente a um efeito pós-juncional / Abstract: Local anesthetics commonly used in clinical practice can interact with neuromuscular blockers and potentiate their effects. Many authors studied this interaction, but the mechanism involved in the potentiation of neuromuscular blockers and the action of local anesthetics in the pre and postjunctional sites were not completely elucidated- In this study, in specific experiments in the neuromuscular junction the following parameters were studied: the effects of the local anesthetics procaine and lidocaine in the neuromuscular transmission; its influence on the neuromuscular blockade produced by d-tubocurarine and by rocuronium; the efficacy of neostigmine and of 4-aminopyhdine in the reversion of the blockade produced by the association of local anesthetics - neuromuscular blockers; the effects of local anesthetics on the membrane potentials and miniature end - plate potentials. It was also evaluated in chronically denervated rat diaphragm preparation and chick biventer cervicis preparation the effects of local anesthetics on acetylcholine contracture. The results were expressed in average and standard deviation and analyzed through the Wilcoxon and Mann-Witney tests, adopting a level of significance of 5% (p <0.05). In rat phrenic nerve diaphragm preparations under indirect electric stimulation, local anesthetics in the concentrations used did not change the amplitude of the muscle response but potentiated the effects of d-tubocurarine and of rocuronium. This blockade was partially and totally reverted by neostigmine and by 4-aminopyridine, respectively. Procaine and lidocaine caused no significant alteration in the membrane potentials, not demonstrating depolarizing action in the muscle fiber. Procaine caused a decrease in the amplitude and frequency of the miniature end - plate potentials {meps) and lidocaine, in contrast, promoted an initial increase in the frequency of meps followed by blockade. In chick biventer cervicis preparations and chronically denervated rat diaphragm, procaine and lidocaine promoted a significant decrease in the response to acetylcholine contracture evidencing a post-junctional effect. The results obtained demonstrate a synergism among the drugs mainly due to a postjunctional effect / Doutorado / Doutor em Farmacologia

La douleur abdominale post chirurgicale reste une douleur difficile à gérer. Cette douleur présente 2 composantes : (1) une composante pariétale liée à l’agression des muscles de la paroi abdominale et du péritoine pariétal et (2) une composante viscérale liée à l’agression du péritoine viscérale et des viscères. La douleur pariétale est bien systématisée, elle correspond à des métamères bien identifiés. Par contre la douleur viscérale est souvent mal localisée, irradiée ou transférée à un site cutané. Les AL administrés par l’intermédiaire d’un cathéter d’infiltration pariétal, d’un bloc de la paroi abdominale ou par voie systémique montrent une efficacité clinique dans l’analgésie post opératoire d’une chirurgie abdominale. Cependant le mécanisme d’action des AL en fonction de leurs voies d’administration n’est pas bien élucidé. Le but de nos études est d’explorer l’effet des AL sur les deux composantes de la douleur abdominale dans un modèle animal en fonction de leur voie d’administration. Nous avons réalisé 3 études expérimentales :1-Dans l’étude 1 nous avons comparé l’effet de la ropivacaïne administrée par voie systémique ou par un cathéter pré péritonéal sur la douleur pariétale et viscérale dans un modèle de laparotomie chirurgicale chez le rat.. 2-Dans l’étude 2 nous avons validé un bloc de la paroi abdominale chez le rat.. 3-Dans l’étude 3 nous avons comparé l’effet de la bupivacaïne par voie systémique à l’effet obtenu par l’administration de la bupivacaïne par un bloc de la paroi abdominale. Nous avons également comparé l’effet des Al par voie systémique à une vagotomie chimique préventive. L’ensemble de ces travaux montrent que lors d’une laparotomie, les AL sont efficaces dans le traitement de la nociception aussi bien par voie systémique que par voie locorégionale. Nous avons démontré qu’un bloc de la paroi abdominale, ainsi qu’une infiltration pré péritonéale diminuaient la transmission de la nociception viscérale vers le SNC par action directe sur les terminaisons nerveuses pariétales. De plus, lors d’une laparotomie, l’administration systémique d’AL montre une efficacité dans l’inhibition de la transmission de la nociception viscérale vers le SNC associée à un effet anti inflammatoire local et systémique supérieure à celui d’une administration locorégionale. / The abdominal post surgical pain has two components : (1) a parietal component due toaggression of the abdominal wall muscles and the parietal peritoneum and (2) a visceralcomponent due to aggression of the visceral peritoneum and viscera. Parietal pain is welllocalized; it corresponds to identified dermatomes. Otherwhise, visceral pain is often badlylocalized. Local anesthetics injected through a parietal catheter of infiltration, an abdominal wall blockor by a systemic administration show clinical efficiency in post operative analgesia afterabdominal surgery. However, the action mechanisms of local anesthetics according to theiradministration route are not well clarified. The purpose of our studies is to explore localanesthetics effect on both components of the abdominal pain in an animal model according totheir administration route.In this purpose we realized three experimental studies :1- In the first study, we compared the effect of systemic administration or through a preperitoneal catheter of ropivacaïne on parietal and visceral pain in a model of surgicallaparotomy in the rat. 2- In the second study, we established a block of the abdominal wall in the rat. 3- In the third study, parietal and peritoneal inflammation were induced by carrageenaninjection in the abdominal wall or in the peritoneal cavity in the rat according to theexperimental group. Then, we compared the effect of a systemic administration of bupivacaïneto its administration by an abdominal wall block. Furthermore, the systemic effect of localanesthetics was compared to a preventive chemical vagotomy. These works showed that during laparotomy, local anesthetics are effective in thetreatment of the nociception as well as by systemic or locoregional administration. We showedthat an abdominal wall block as well as a pre peritoneal administration decreased thetransmission of the visceral nociception towards the central nervous system by direct action onthe parietal nerve endings. Furthermore, during a laparotomy, systemic administration of localanesthetics inhibited the transmission of visceral nociception towards the central nervoussystem associated with a local and systemic anti inflammatory effects. This anti inflammatoryeffect was higher than that what we showed by locoregional administration of bupivacaïne.

The temporomandibular myofascial pain presents a major challenge in the diagnosis of temporomandibular disorders. Due to the characteristics of this condition, intramuscular injection procedures are often needed for adequate control of symptoms and treatment. Thus, the aim of this study was to evaluate the effectiveness of injection with different substances or dry needling in temporomandibular myofascial pain. The study design consisted of a systematic review of randomized clinical trials and research databases consulted were: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus and Web of Science until October 2014. The selection of studies was carried out by two independent reviewers, who applied eligibility criteria to obtain the final sample of primary studies. After application of the inclusion criteria were selected fifteen studies. Due to the heterogeneity of the primary studies it was not possible to perform a meta-analysis. The narrative analysis of the results showed that most of the studies had methodological limitations and biases that have compromised the quality of its findings. Thus, there is a need of conducting further randomized clinical trials, with follow-up and larger samples, to evaluate the real effectiveness of the technique and evaluated substances. / A dor miofascial temporomandibular apresenta um grande desafio diagnóstico dentro das Disfunções Temporomandibulares. Devido às características dessa condição, procedimentos de infiltração intramuscular muitas vezes são necessários para o adequado controle e tratamento dos sintomas. Assim, o objetivo desse estudo é avaliar a efetividade de infiltrações com diferentes substâncias ou agulhamento à seco em dor miofascial temporomandibular. O delineamento do estudo consistiu em uma revisão sistemática de ensaios clínicos randomizados e as bases de pesquisa consultadas foram: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus e Web of Science no período até outubro de 2014. A seleção dos estudos foi realizada por dois avaliadores independentes, que aplicaram critérios de elegibilidade para a obtenção da amostra final de estudos primários. Após a aplicação dos critérios de inclusão quinze estudos foram selecionados. Devido à heterogeneidade dos estudos primários não foi possível realizar uma meta-análise. A análise narrativa dos resultados mostrou que a maioria dos estudos apresentava limitações metodológicas e vieses que comprometeram a qualidade de seus achados. Assim, existe a necessidade da condução de novos ensaios clínicos randomizados, com tempo de acompanhamento e amostras maiores, para avaliar a real efetividade da técnica e das substâncias avaliadas.