Abstract The International Association for the Study of Pain chose pain prevention as the theme for the 2020 Global Year. Chronic postoperative pain is one the many types of pain that can be potentially prevented. It develops or increases in severity after a surgery, persists for at least three months, even after ruling out all other possible causes of pain. To perform the present narrative review, the authors searched the PubMed database using the following keywords “postoperative pain” OR “postsurgical pain” AND “chronic” OR “persistent”. The present review focused on the incidence, pain development and chronification, and predisposing factors. It also discusses prevention, diagnosis, and treatment of chronic postoperative pain. Awareness of occurrence of chronic postoperative pain and recognizing risk factors is crucial for the day-to-day practice of the anesthesiologist. Hence, numerous surgical patients can have their outcome improved by preventing chronic postoperative pain, a condition scarcely identified and without a well-established treatment.

Abstract Background and aims: Rocuronium may provide excellent onset time, but high doses are required for effective action. Several strategies have managed to shorten rocuronium onset time, including the use of Magnesium Sulphate (MgSO4). Methods: One hundred and eighty patients were randomized into six groups according to rocuronium dose received (0.3, 0.6 or 1.2 mg.kg-1) and the administration of saline or MgSO4 (60 mg.kg-1). Correlations between tissue perfusion and rocuronium onset time was determined by variations in perfusion index. Results: Median (quartiles) rocuronium onset times were 85.5 (74.0–92.0); 76.0 (52.0–87.0) and 50.0 (41.0–59.5) seconds for 0.3, 0.6 mg.kg-1 and 1.2 mg.kg-1 doses, respectively. MgSO4 decreased rocuronium onset at doses of 0.3 mg.kg-1 (60.0 [48.0–74.3] seconds) and 0.6 mg.kg-1 (44.0 [39.0–49.0] seconds) but not at 1.2 mg.kg-1 (38.0 [33.5–56.3] seconds) (p< 0.001). Perfusion index variations in groups that received MgSO4 were greater than in controls. A negative correlation between shorten onset and increased perfusion index was observed in rocuronium doses of 0.3 mg.kg-1 (r = -0.50; p < 0.001) and 0.6 mg.kg-1 (r = -0.424; p< 0.001), but not for 1.2 mg.kg-1 dose (r = -0.25; p = 0.07). Conclusion: MgSO4 reduces rocuronium onset time at doses of 0.3 mg.kg-1 and 0.6 mg.kg-1 being that the latter has a similar effect when compared to the dose of 1.2 mg.kg-1, with or without the use of MgSO4.

ABSTRACT Centrifugal spinning is a new technique for producing of nano and microfibers that has a great differential: a higher production rate than those presented by traditional methods. Due to a great interest in using nano and microfibers in technological applications along with the environmental interest in polymer recycling, this research had the purpose of production fibers by centrifugal spinning from the expanded poly-styrene recycling and the evaluation of the influence of operational parameters such as the concentration of polymer solution and the speed of rotation in the average diameter and in the distribution of the diameters of fibers formed. The fibers obtained were characterized using the Scanning Electronic Microscopy (SEM) and they had their diameters measured using ImageJ software. The fibers obtained in this research were entangled, woven, fused, with a rough and porous surface, with bead formation and without directional ordering. The results obtained show that the polymer solution concentration was the most influential parameter in the fibers analyzed characteristics and, in general, its increase generates an increase in the average diameter. With the increase in rotation speed, there has been often a reduction in the presence of beads and microparticles due to the better stretching of the fibers. In less concentrated solutions, continuous fibers with more regular surfaces were obtained, however, promoting the higher production of beads. In the most concentrated solutions, we noticed the formation of porous fibers and very rough surfaces, as well as fused and woven fibers. Through the measurement of its diameters, it was possible to observe the obtaining of fibers with average diameters of 407,02 nm to 38113,20 nm, and the smallest value was obtained with the parameters of 5% w/w of polymer concentration and rotation speed of 15000 rpm and the highest value had 15% w/w concentration polymer and 10000 rpm.

Resumo Justificativa e objetivos: Os avanços da medicina, incluindo a anestesiologia e reanimação, têm tornado cada vez mais rara a ocorrência da morte natural. Como consequência, as práticas de distanásia se tornaram habituais em uma realidade que não mais se justifica. Este estudo objetiva avaliar o conhecimento de anestesiologistas brasileiros dos institutos da distanásia e ortotanásia. Para tal, investigamos as preferências de condutas desses profissionais, dentre aquelas práticas, bem como a contribuição da graduação médica na abordagem das questões relacionadas à morte. Método: Coorte prospectivo, descritivo, com abordagem quantitativa, com a inclusão de 150 anestesiologistas inscritos na Sociedade Brasileira de Anestesiologia e que foram convidados a participar por mensagem de e-mail. Aplicou-se questionário online, contendo 38 questões, elaborado pelos pesquisadores. A pesquisa foi aprovada pela Comissão de Ética em Pesquisa instrucional. Resultados: Os anestesiologistas, embora afirmem conhecer a distanásia e a ortotanásia, em sua maioria adquiriram esse conhecimento fora da graduação. Diante da terminalidade do próprio entrevistado, do seu paciente ou de um ente querido, prefere a ortotanásia, a morte em casa, priorizando a dignidade. Entretanto, esses especialistas afirmam já terem praticado, contrariados, a distanásia, mesmo quando a ortotanásia era a melhor conduta, o que lhes gerou sentimentos negativos. Quase a integralidade dos entrevistados afirmou não ter tido, na graduação, treinamento prático de conduta frente à terminalidade, embora se sinta capaz de identificá-la. A maioria não conhece a Resolução do Conselho Federal de Medicina 1.805/06 que viabiliza a prática da ortotanásia. Não há influência da religião e da região político-administrativa de residência do anestesiologista sobre as suas preferências. Conclusões: Os anestesiologistas afirmam ter conhecimento sobre distanásia e ortotanásia e preferem, diante da terminalidade, praticar a ortotanásia, embora a distanásia seja habitual, o que resulta em frustração e indignação. O ensino da graduação médica é deficitário em questões relacionadas à morte.

Abstract Background and objectives: Advances in medicine, including anesthesiology and resuscitation, have made natural death increasingly rare. As a consequence, dysthanasia has become usual in a scenario for which there is not rationale. The present study aimed to assess the level of knowledge of Brazilian anesthesiologists on the principles of dysthanasia and orthothanasia. Thence, we studied the management preferences of these professionals, vis-à-vis those practices, as well as how medical school contributed to addressing death-related issues. Method: Quantitative approach, prospective and descriptive cohort that included 150 anesthesiologists, members of the Brazilian Society of Anesthesiology, and who were invited to participate by email. An online questionnaire containing 38 questions was prepared by the authors. The study was approved by the Instructional Research Ethics Committee. Results: Anesthesiologists, although claiming to know dysthanasia and orthothanasia, mostly acquired knowledge outside medical school. If faced with their own end of care, or of a patient or a loved one, they prefer orthothanasia, to die at home, prioritizing dignity. However, the specialists claimed to have already practiced dysthanasia, even when orthothanasia was the choice management, which caused them negative feelings. Almost all respondents stated that they did not have practical training in undergraduate school on how to face end-of-life issues, although they felt capable of identifying it. Most were not aware of the Brazilian Federal Council of Medicine Resolution 1.805/06 that makes practicing orthothanasia feasible. Anesthesiologists’ religion or the political-administrative region of residence had no effect on their preferences. Conclusions: Anesthesiologists claim to have knowledge on dysthanasia and orthothanasia, but prefer, in the face of a terminally ill patient, to practice orthothanasia, although dysthanasia is usual, and results in frustration and indignation. The medical school curriculum is unsatisfactory in addressing death-related issues.

RESUMO JUSTIFICATIVA E OBJETIVOS: As experiências dolorosas as quais o recém-nascido é submetido podem ter relação com reações futuras e que existem diferenças no comportamento de resposta à dor nos recém-nascidos oriundos de diferentes vias de parto. O estudo teve como objetivo avaliar a resposta à dor em bebês nascidos por cesariana e parto vaginal. MÉTODOS: Estudo coorte prospectivo que incluiu recém-nascidos nascidos a termo, de cesariana e parto vaginal. Utilizou-se, como estímulo doloroso agudo, a injeção intramuscular de vitamina K rotineira ao nascimento. Os recém-nascidos foram avaliados quanto à dor pela escala unidimensional Neonatal Facial Coding System e pela multidimensional COMFORT Behavior Scale (Comfort b), além da frequência cardíaca nos momentos antes, imediatamente após e 10 minutos após o estímulo. Foi utilizado teste t de Student para a análise estatística com significância de 5%. RESULTADOS: Foram avaliadas 83 crianças. A intensidade da dor avaliada por ambas as escalas antes do estímulo doloroso foi maior no grupo de recém-nascidos de cesariana, porém não foi estatisticamente significativa. Os valores da frequência cardíaca após o estímulo mostraram diferença estatisticamente significativa (p<0,05) maiores no grupo cesariana que no parto vaginal. CONCLUSÃO: Os dados obtidos não evidenciaram diferenças na percepção da dor entre recém-nascidos de parto vaginal e cesariana.

ABSTRACT BACKGROUND AND OBJECTIVES: It is already known that the painful experiences to which the newborn is subjected may be related to future reactions and differences in the behavioral response to pain in newborns from different birth routes. This study aimed to evaluate the response to pain in infants born by cesarean section and vaginal delivery routes. METHODS: This is a prospective cohort study. Newborns born at full term were allocated into two groups: cesarean section and vaginal delivery. The intramuscular vitamin K injection was performed as an acute pain stimulus because it is a routine injection at birth. The newborns were evaluated for pain on two scales, a one-dimensional, the Neonatal Facial Coding System, and a multidimensional, the COMFORT Behavior Scale (Comfort b), in addition to heart rate counting, moments before, immediately after and 10 minutes after the stimuli. Students t-test was used for statistical analyzes, and the level of significance was 5%. RESULTS: Eighty-three children were evaluated. The pain intensity assessed by both scales before the pain stimulus was higher in the cesarean section group, but not statistically significant. Heart rate values after the stimulus showed a statistically significant difference (p<0.05), higher in the cesarean section group than in the vaginal delivery. CONCLUSION: The results did not suggest that there are differences in the perception of pain among newborns born vaginally and cesarean section.

Resumo Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada.

Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.