Estudo Multimodal da Dor em Pacientes com Retalho Livre

Estudo prospectivo controlado randomizado para comparar dois padrões de cuidados para o manejo da dor em cirurgia de cabeça e pescoço. O braço A incluirá:

• Tylenol programado 1000 mg IV uma dose única no intraoperatório, depois 650 mg via tubo PEG ou PO Q4H até uma dose máxima de 4 g/24 horas
• Opioides prn com base na Escala Numérica de Dor (0-10, com 0 indicando nenhuma dor e 10 indicando a pior dor de todas):
• 0-3: sem remédios prn, tranquilização, ouvir música, assistir TV.
• 4-7: Oxicodona 5 mg q4h prn via tubo PEG ou PO com máximo de 30 mg/24 horas.
• 8-10 Morfina 2 mg IV a cada 2 horas prn dor irruptiva.

Braço B, incluirá:

• Arm Uma descrição com adição..
• Cetorolaco programado começando no dia 1 pós-operatório, 15 mg a cada 6 horas (máximo de 120 mg/dia), por um total de 5 dias
• Gabapentina programada começando 7 dias antes da cirurgia para continuar no pós-operatório
• Bloqueio regional por protocolo de anestesia - Bloqueio inicial: bupivacaína a 0,5%, 20 ml Infusão contínua: bupivacaína a 0,125% a 6 ml/h com bolus de 5 ml disponível a cada 30 minutos

Pain was measured on a Likert scale from 0 to 10 (i.e. 0 being the lowest and 10 being the greatest amount of pain). Baseline pain (P0) was measured on this scale for each patient in the preoperative setting. Pain was similarly assessed at regular intervals post-operatively during hospitalization (Pn).

Patient pain percentage was subsequently defined as follows:

{ 100*[(P_n/P_0) -1]│ n∈N, n≥1}

Where:

P_0: the baseline (initial) measurement taken at time t=0. P_n: the measurement taken at the nth time interval after baseline, where n∈N, n≥1

Interpretation of "pain percentage compared to baseline":

• A value of 0% indicates no change from baseline pain
• Negative values indicate lower pain than baseline
• Positive values indicate higher pain than baseline
• Therefore, lower values represent a better outcome and higher values represent a worse outcome

Each of the domain of ABC pain index is weighted (mult_D) based on relative importance.

For each domain D ∈{sleep, lying, sitting, oob, walk}, let:

D_able∈{1,2,3}, (1 = able with pain; 2 = unable due to pain; 3 = unable for other reasons) D_pain∈[0, 5] (reported pain score)

Then if:

D_able = 1 numerator_D = D_pain × mult_D denominator_D = 1 +(5×mult_D) D_able=2 numerator_D = 1 + (5×mult_D) denominator_D= 1 + (5×mult_D ) D_able=3 numerator_D = 1 denominator_D = 1

For the site-specific domains D ∈{h&n,flap,graft}, let:

D_present∈{1,2} (1=present; 2=absent) D_pain∈[0, 5] (reported pain score)

Then if:

D_present=1:

numerator_D = D_pain × mult_D denominator_D = 5 × mult_D

D_present=2:

numerator_D = 0 denominator_D = 0

Patient Pain Assessment Percentage:

ABC_numerator = sum(numerator_D) ABC_denominator = sum(denominator_D) ABC_percentage = ABC_numerator / ABC_denominator This ranges from 0-100%. Lower values are better, higher values are worse.