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- ItemAcesso aberto (Open Access)Bupivacaine and botulinum toxin to treat comitant strabismus(Conselho Brasileiro de Oftalmologia, 2012-04-01) Hopker, Luisa Moreira [UNIFESP]; Zaupa, Priscila Fernandes [UNIFESP]; Lima Filho, Acácio Alves de Souza [UNIFESP]; Cronemberger, Monica Fialho [UNIFESP]; Tabuse, Marcia Keiko Uyeno [UNIFESP]; Nakanami, Célia Regina [UNIFESP]; Allemann, Norma [UNIFESP]; Mendonça, Tomás Scalamandré [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique). RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.
- ItemAcesso aberto (Open Access)Concentração eficaz mínima de bupivacaína em bloqueio do nervo femoral guiado por ultrassom após meniscectomia artroscópica de joelho: estudo randomizado, duplo-mascarado(Universidade Federal de São Paulo (UNIFESP), 2015-03-31) Moura, Ed Carlos Rey [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Leal, Plínio da Cunha [UNIFESP]; http://lattes.cnpq.br/2150178332757393; http://lattes.cnpq.br/9796401471904195; http://lattes.cnpq.br/1952516967110832; Universidade Federal de São Paulo (UNIFESP)Objetivos: Um dos requisitos para alta hospitalar é a analgesia adequada. O bloqueio do nervo periférico pode reduzir a necessidade de analgésicos sistêmicos; entretanto, pode ocorrer bloqueio motor, dependendo da concentração do anestésico local utilizado. Guiado por ultrassom, a concentração de anestésico local pode ser reduzido. O objetivo primário deste estudo foi obter a concentração analgésica eficaz mínima da bupivacaína no bloqueio femoral guiado por ultrassom para meniscectomia artroscópica de joelho. Métodos: Este estudo foi prospectivo, randomizado, duplo-cego. Um total de 52 pacientes foram submetidos a meniscectomia artroscópica do joelho e receberam bloqueio femoral guiada por ultrassom usando 22 ml de bupivacaína. A concentração de bupivacaína dada a um paciente foi determinada pela resposta do paciente anterior (a biased-coin design up?down sequential method). Se teve uma resposta negativa, a concentração de bupivacaína foi aumentada em 0,05% no próximo paciente. Se teve uma resposta positiva, o próximo paciente foi randomizado para receber a mesma concentração de bupivacaína (com uma probabilidade de 0,89) ou para receber uma concentração de 0,05% menor (com uma probabilidade de 0,11). Sucesso de bloqueio foi definida como dor <4 na escala numérica da intensidade da dor (0 = sem dor e 10 = pior dor imaginável) em três diferentes tempos de avaliação. Se dor > ou igual 4 o bloqueio foi caracterizado como um fracasso, porque provavelmente precisaria de drogas analgésicas mais potentes (opióides) e retardaria a alta precose do paciente, saindo do foco primário do estudo. Foram submetidos a anestesia geral com alfentanil 30 ug/Kg, propofol 2mg/Kg, manutenção com propofol, havendo necessidade poderia receber remifentanil. A complementação da analgesia pós-operatória foi com dipirona e se necessário, cetoprofeno e tramadol (50mg). Foram avaliados: intensidade de dor, duração da analgesia, dose de analgésico complementar e consumo de remifentanil. Resultados:. A CEM50 foi de 0,160% (IC 95%: 0,150-0,189) e a CEM90 foi de 0,271% (IC 95% : 0,196-0,300). O tempo para solicitação da primeira dose de analgésico foi de 463 ± 245,9 min, sendo que em concentrações superiores a 0,3% foi de 604,3 ± 255,2 min. Conclusões: A CEM da bupivacaína para analgesia em bloqueio femoral guiado por ultrassom em 50% dos pacientes foi de 0,160%, e em 90% dos pacientes, foi de 0,271%.
- ItemAcesso aberto (Open Access)Determinação do volume mínimo efetivo de bupivacaína 0,5% para bloqueio do plexo braquial por via axilar guiado por ultrassom(Sociedade Brasileira de Anestesiologia, 2014-01-01) Ferraro, Leonardo Henrique Cunha [UNIFESP]; Takeda, Alexandre; Falcão, Luiz Fernando dos Reis [UNIFESP]; Rezende, André Hosoi [UNIFESP]; Sadatsune, Eduardo Jun; Tardelli, Maria Angela [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background and objective:The use of ultrasound for needle correct placement and local anesthetic spread monitoring helped to reduce the volume of local anesthetic required for peripheral nerve blocks. There are few studies of the minimum effective volume of local anesthetic for axillary brachial plexus block. The aim of this study was to determine the minimum effective volume (VE90) of 0.5% bupivacaine with epinephrine (1:200,000) for ultrasound guided ABPB.Method:Massey and Dixon's up-and-down method was used to calculate the minimum effective volume. The initial dose was 5 mL per nerve (radial, median, ulnar, and musculocutaneous). In case of blockade failure, the volume was increased to 0.5 mL per nerve. A successful blockade resulted in decreased volume of 0.5 mL per nerve to the next patient. Successful blockade was defined as a motor block ≤2, according to the modified Bromage scale; lack of thermal sensitivity; and response to pinprick. The achievement of five cases of failure followed by success cases was defined as criterion to complete the study.Results:19 patients were included in the study. The minimum effective volume (VE90) of 0.5% bupivacaine with 1:200,000 epinephrine was 1.56 mL (95% CI, 0.99-3.5) per nerve.Conclusion:This study is in agreement with some other studies, which show that it is possible to achieve surgical anesthesia with low volumes of local anesthetic for ultrasound-guided peripheral nerve blocks.
- ItemAcesso aberto (Open Access)Estudo da retina de coelhos após injeção intravítrea de bupivacaína(Conselho Brasileiro de Oftalmologia, 2002-08-01) Oliveira Neto, Hermelino Lopes De [UNIFESP]; Farah, Michel Eid [UNIFESP]; Smith, Ricardo Luiz [UNIFESP]; Martins, Maria Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate morphologic alterations caused by intravitreous injection of bupivacaine, a long-term local anesthetic agent much used in ocular regional blockades, in the retina of albino rabbits. Methods: The drug was injected at a 0.75% in 0.1ml concentration into the vitreous, close to the retina in one eye, while an equal volume of balanced saline solution was injected into the other eye (control), with indirect ophthalmoscopy performed before, during and immediately after the procedure and at 1hour, 24 hours and 72 hours; both light and electron microscopy were performed at 24 and 72 hours after administration of the anesthetic agent. Results: Immediately following the injection of bupivacaine, ophthalmoscopy re-vealed the retina to have in all cases a whitened aspect close to the injection site, a phenomenon attributed to the presence of spreading depression, which was also found (at less frequency and intensity), in the control eyes. Further found alterations included: retina edema, 6 (60%); area of vitreous condensation, 5 (50%); and papilla pulse, 2 (20%). Conclusions: Intravitreous injection of bupivacaine at 0.75% concentration (used for retrobulbar, peribulbar local anesthesia or a different technique in extended eye surgeries) triggered no morphological alterations when studied by light microscopy; the injection however did trigger mild edema-suggesting alterations in the horizontal cells of the retina of albino rabbits, studied by electron microscopy within the 24 and 72-hour periods.
- ItemSomente MetadadadosHistological changes underlying bupivacaine's effect on extra ocular muscle(Academic Press Ltd- Elsevier Science Ltd, 2018) Hopker, Luisa Moreira [UNIFESP]; Neves, Juliana de Carvalho; Nascimento, Daiane Jaqueline; Campos, Eliene Dutra; Mendonca, Tomas Scalamandre [UNIFESP]; Zanoteli, Edmar; Allemann, Norma [UNIFESP]To determine the changes in the cross-sectional area (CSA) of myofibers and their subtype distribution based on the myosin isoform expression after bupivacaine (BUP) injection in the EOM of rabbits and help the understanding of strabismus correction after BUP injection in the clinical practice. A total of 32 rabbits received 0.3 mL of 1.5% BUP in the superior rectus muscle (SR) of the right eye (OD) and were sacrificed at days 7, 28, 60, and 92. Additional eight untouched rabbits were included as controls. Hematoxylin and eosin staining was performed, and ImageJ software was used to measure CSA. Immunohistochemical analysis was performed to analyze the proportion of myofibers positive for myosin types 1 (slow), 2 (fast) and embryonic. Myofiber area measurement decreased 7 days after BUP injection [SR, 1271 +/- 412 mu m(2) (control) to 909 +/- 255 mu m(2) (day 7)] after BUP injection, followed by an increasing trend after 28 days and normalization after 92 days [SR
- ItemAcesso aberto (Open Access)Infraorbital nerve block for postoperative pain following cleft lip repair in children(Wiley, 2016) Feriani, Gustavo; Hatanaka, Eric [UNIFESP]; Torloni, Maria Regina [UNIFESP]; da Silva, Edina M. K. [UNIFESP]Background Postoperative pain is a barrier to the quality of paediatric care, the proper management of which is a challenge. Acute postoperative pain often leads to adverse functional and organic consequences that may compromise surgical outcome. Cleft lip is one of the most common craniofacial birth defects and requires surgical correction early in life. As expected after a surgical intervention in such a sensitive and delicate area, the immediate postoperative period of cleft lip repair may be associated with moderate to severe pain. Infraorbital nerve block associated with general anaesthesia has been used to reduce postoperative pain after cleft lip repair. Objectives To assess the effects of infraorbital nerve block for postoperative pain following cleft lip repair in children. Search methods We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, Issue 6, 2015), MEDLINE, EMBASE, and Literatura Latino-Americana e do Caribe em Ciencias da Saude (LILACS) from inception to 17 June 2015. There were no language restrictions. We searched for ongoing trials in the following platforms: the metaRegister of Controlled Trials
- ItemAcesso aberto (Open Access)Intra-articular morphine versus bupivacaine for knee motion among patients with osteoarthritis: randomized double-blind clinical trial(Associação Paulista de Medicina - APM, 2008-11-01) Gazi, Miriam Bellini [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Issy, Adriana Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Osteoarthritis causes pain and disability in a high percentage of elderly people. The aim of the present study was to assess the efficacy of intra-articular morphine and bupivacaine on the joint flexion and extension angles of patients with knee osteoarthritis. DESIGN AND SETTING: A randomized double-blind study was performed at a pain clinic of Universidade Federal de São Paulo (UNIFESP). METHODS: Thirty-nine patients with pain for more than three months, of intensity greater than three on a numerical scale (zero to 10), were included. G1 patients received 1 mg (1 ml) of morphine diluted in 9 ml of saline, intra-articularly, and G2 patients received 25 mg (10 ml) of 0.25% bupivacaine without epinephrine. Pain was assessed on a numerical scale and knee flexion and extension angles were measured after administration of the drugs at rest and during movement. The total amount of analgesic supplementation using 500 mg doses of paracetamol was also determined. RESULTS: No significant difference in pain intensity was observed between G1 and G2. Significant decreases in pain at rest and during movement and significant increases in mean flexion and extension angles were observed in both groups, with no significant difference between the two groups. The mean total amount of paracetamol used over a seven-day period was 3578 mg in G1 and 5333 mg in G2 (P = 0.2355; Mann-Whitney test). CONCLUSION: The analgesic effects of 1 mg of morphine and 25 mg of 0.25% bupivacaine were similar among patients with osteoarthritis of the knee.
- ItemAcesso aberto (Open Access)Pharmacokinetic and clinical effects of two bupivacaine concentrations on axillary brachial plexus block(Elsevier Science Inc, 2018) Ferraro, Leonardo Henrique Cunha [UNIFESP]; Takeda, Alexandre [UNIFESP]; Barreto, Cleber N. [UNIFESP]; Faria, Bernadete [UNIFESP]; Assunção, Nilson Antonio [UNIFESP]Introduction: The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. Methods: 30 patients were randomized. In the 0.25% Group, 0.25% bupivacaine (10 mL) was injected per nerve. In the 0.5% Group, 0.5% bupivacaine (5 mL) was injected per nerve. Peripheral blood samples were collected during the first 2 hours after the blockade. For sample analyses, high performance liquid chromatography mass spectrometry was used. Results: Plasma peak occurred 45 minutes after the blockade, with no difference between groups at the assessed time-points. Plasma peak was 933.97 +/- 328.03 ng.mL(-1) (mean +/- SD) in 0.25% Group and 1022.79 +/- 253.81 ng.mL(-1) in 0.5% Group (p = 0.414). Latency was lower in 0.5% Group than in 0.25% Group (10.67 +/- 3.71 x 17.33min +/- 5.30, respectively, p = 0.004). No patient had pain within the first 4 hours after the blockade. Conclusion: For axillary brachial plexus block, there was no difference in bupivacaine plasma peak despite the use of different concentrations with the same local anesthetic mass. The concentration inversely influenced latency. (C) 2017 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.