Abstract Background and objectives: Abdominal Hysterectomy (AH) is associated with significant inflammatory response and can result in moderate to severe postoperative pain. This study aimed to evaluate the efficacy of magnesium infusion in reducing postoperative pain and analgesic consumption after AH under spinal anesthesia with Intrathecal Morphine (ITM). Method: Eighty-six patients were included in this clinical, controlled, randomized, double-blind study. Patients received in Group Mg, MgSO4 50 mg kg−1 for 15 minutes followed by 15 mg kg−1 h−1 until the end of the surgery; and in Group C, (control) the same volume of isotonic saline. Both groups received 100 µg of ITM. All patients received dipyrone + ketoprofen intraoperatively and postoperatively, and dexamethasone intraoperatively only. We evaluated the intensity of pain, tramadol consumption, and adverse events 24 hours postoperatively. Results: Serum magnesium concentrations were higher in Group Mg at the end, and one hour after the operation (p = 0.000). Postoperative pain scores were reduced in Group Mg at 6 hours at rest and on movement (p < 0.05). Tramadol consumption did not show a statistically significant difference between Group Mg and Group C (15.5 ± 36.6 mg and 29.2 ± 67.8 mg respectively, p = 0.53). Hemodynamic variables, the incidence of pruritus, nausea, and vomiting were similar in the two groups. Conclusion: Infusion of MgSO4 during AH undergoing spinal anesthesia with ITM reduced at 6 hours at rest and on movement. More studies should be performed to evaluate the potential antinociceptive effect of MgSO4 in scenarios where a multimodal analgesia approach was employed.

OBJETIVOS: Avaliar a aplicabilidade da tipologia e caracterizar os subtipos identificados. MÉTODOS: Características de 300 homens alcoolistas atendidos em um programa ambulatorial foram submetidas à análise de cluster para separá-los em dois subgrupos de acordo com a tipologia de Babor et al. Efetivaram-se cruzamentos de dados (significância avaliada pelo Teste do qui-quadrado de Pearson) para se verificar a associação dos clusters com variáveis clínicas e demográficas. RESULTADOS: Comparado ao outro grupo e pacientes, um dos clusters identificados foi caracterizado por um perfil de maior gravidade clínica. Pacientes do subtipo menos grave foram mais frequentemente (65,3%) encaminhados a tratamentos simbólicos, enquanto pacientes do subtipo mais grave foram atendidos predominantemente (58,5%) por abordagem exclusivamente farmacológica e aderiram mais ao tratamento proposto. CONCLUSÕES: Como os resultados identificaram subtipos de alcoolistas com distintas características, este estudo evidenciou a aplicabilidade clínica da tipologia de Babor et al. em nosso meio sociocultural¹. Também aponta para a relevância de estudos tipológicos que possam contribuir para uma mais ampla compreensão dos aspectos etiológicos, preventivos e terapêuticos do alcoolismo.

OBJECTIVE: To test the applicability of this typology and to characterize the identified subtypes. METHODS: Characteristics of 300 alcoholic men attending an out-treatment program were submitted to cluster analysis for identification of two subgroups (clusters), according to the original classification. Cross-tabulations were then performed to test for possible association of identified clusters to demographic and clinical features. Statistical significance was given by Pearson chi-square tests. RESULTS: Compared to the other group, one of the identified clusters was characterized by a more severe clinical profile. Patients of the mild subtype were principally (65,3%) referred to symbolic treatments while patients of the severe subtype were mainly assisted (58,5%) exclusively through a pharmacological approach and remained in treatment for longer periods of time. CONCLUSIONS: As the results identified subtypes of alcoholics with differential features, this study brought forth the clinical applicability of Babor et al. typology in our social-cultural context¹. Results also point to the relevance of typological studies that may contribute to a more adequate understanding of etiological, preventive and therapeutic aspects of alcoholism.

OBJETIVO: A medida da adesão tem sido considerada alternativa objetiva e versátil para avaliação do resultado do tratamento de alcoolistas. Este estudo avaliou fatores associados à adesão de alcoolistas atendidos em um programa ambulatorial. MÉTODO: Foram estudados 300 alcoolistas que concluíram a fase de avaliação do programa e avaliada a associação da adesão dos pacientes ao tratamento a todas as mais de mil variáveis do banco de dados do programa, utilizando o teste qui-quadrado de Pearson (p < 0,1). RESULTADOS: Entre as variáveis que se associaram positivamente à adesão foram identificadas: ter filhos; relação conjugal estável; afirmar problemas psicológicos; ter sofrido esquecimento ou fraqueza recentemente; sentir-se irritado quando alcoolizado; beber sozinho; apresentar comorbidade psiquiátrica; já ter procurado tratamento para alcoolismo, tratamento em psiquiatria; uso anterior de antidepressivos etc. Associaram-se negativamente: reduzir consumo por influência familiar; sentir-se auto-suficiente, expansivo, insatisfeito quando sóbrio; sentir-se auto-suficiente ou conformado quando alcoolizado; início do consumo com idade acima da média do grupo; ter-se envolvido em agressão física com amigos etc. CONCLUSÃO: Os resultados sugerem a necessidade de desenvolvimento de estratégias diferenciadas para o cuidado de determinados grupos de pacientes e contribuem para a simplificação das rotinas de avaliação de alcoolistas.

OBJECTIVE: The evaluation of adherence to treatment has been considered an objective and versatile alternative to alcoholism treatment result assessment. The purpose of this study is to identify factors associated with adherence to an outpatient alcoholism treatment program. METHOD: This study included 300 alcoholic patients that concluded the program assessment stage. Crosstabs were performed to verify the association of adherence to treatment on all other (more than 1,000) variables in the data bank. Statistical significance was given by Pearson's Qui-square test (p < 0.1). RESULTS: Among variables with a positive association to adherence were: to have children and stable matrimonial relationship; affirm psychological problems; lately noticed forgetfulness and weakness; felt irritability when drunk, consuming it alone; present a psychiatric comorbidity; had already looked for alcoholism treatment, got help from AA, psychiatric treatment and made use of antidepressants; etc. Negative associations were: reduced consumption due to family influence; felt self-sufficiency, expansive and unsatisfied while sober; self-sufficient or resigned when under alcohol; first consumptions above group's average age; involved in physical aggression with friends; etc. CONCLUSIONS: These findings suggest the need of developing particular therapeutic strategies to address specific groups of patients and also contribute to the simplification of alcoholism assessment routines.