Márcio Matsumoto

Hospital Sírio-Libanês

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Raquel Chacon Ruiz Martinez

Universidade de São Paulo

Pedro Paulo Kimachi

Hospital Sírio-Libanês

Rosana L. Pagano

Hospital Sírio-Libanês

Rodrigo Moreira e Lima

University of Manitoba

Vera Lúcia Lanchote

Universidade de São Paulo

Gabriela Rocha Lauretti

Universidade de São Paulo

Anita L. Mattos

Hospital Moinhos de Vento

Lucas Wynne Cabral

Universidade Federal de Sergipe

L Mathías

Faculdade de Ciências Médicas da Santa Casa de São Paulo

Leonardo de Andrade Reis

Universidade Federal da Bahia

Cooperative Institutions

Hospital Sírio-Libanês

Universidade de São Paulo

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Hospital São Paulo

Irmandade da Santa Casa de Misericórdia de São Paulo

Universidade Estadual Paulista (Unesp)

Insper

Faculdade de Ciências Médicas da Santa Casa de São Paulo

Universidade de Ribeirão Preto

Universidade Brasil

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Avaliação clínica e laboratorial da cetamina transdérmica, do fentanil transdérmico, da clonidina transdérmica ou suas associações na dor lombar crônica

Gabriela Rocha Lauretti Márcio Matsumoto Anita L. Mattos Vera Lúcia Lanchote Newton Lindolfo Pereira

OBJETIVOS: a dor lombar cronica pode resultar em sensibilizacao central, com a participacao de diferentes tipos de receptores. O objetivo deste estudo foi avaliar a acao analgesica por via transdermica (T) do fentanil, cetamina, clonidina ou suas associacoes para o alivio da dor lombar cronica. METODOS: apos aprovacao do Comite de Etica em Pesquisa e assinatura do termo de consentimento livre e esclarecido, 54 pacientes foram avaliados de forma prospectiva, aleatoria e duplamente-encoberta, sendo divididos em 6 grupos. Cada paciente recebeu duas preparacoes por via transdermica, aplicadas em bracos diferentes (T cetamina (1 mg/h), T clonidina (25 µg/h) ou T fentanil (25 µg/h), associados a T placebo (CloG, CetG and FenG); ou a associacao de T cetamina e clonidina (Cet-CloG), T fentanil e cetamina (Fen-CetG), ou T fentanil e clonidina (Fen-CloG). A analgesia e a incidencia de efeitos adversos foram avaliadas. A analgesia foi avaliada com: 1) VAS-cm, e 2) niveis plasmaticos de noradrenalina as 0-h (antes da aplicacao T), 3- e 6-h apos a aplicacao T, com HPLC. RESULTADOS: clinicamente, os valores de VAS as 6-h foram menores comparados ao tempo de 0-h para todos os grupos (p<0,02), e menores para o Fen-CloG e Fen-CetG as 6-h em relacao a administracao de cada droga T isolada (p<0,05). A administracao de fentanil T (FenG) resultou em diminuicao dos niveis de noradrenalina plasmatica as 6-h (p<0,01), enquanto a associacao de fentanil T com clonidina T resultou em diminuicao de noradrenalina plasmatica as 3-h e 6-h em comparacao aos demais grupos (p<0.01). A combinacao de cetamina e clonidina (Cet-CloG) nao ofereceu melhor perfil analgesico e resultou em sedacao excessiva (p<0,02). CONCLUSOES: todos os grupos apresentaram melhora clinica (VAS) da dor as 6-h. Entretanto, somente quem recebeu fentanil T apresentou niveis plasmaticos de noradrenalina mais baixos as 6-h (quando combinado com placebo) e as 3-h quando associado a clonidina T.

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Improved Functional Limitations and Decreased Pain in Preoperative Period after Pericapsular Nerve Group Block in Proximal Femoral Fractures

Annals of Case Reports (2023)

Pedro Paulo Kimachi Luana Carmélia De Lira Fernandes João Filho Nayra Funato Menezes Márcio Matsumoto

Abstract Background: Proximal femoral fractures commonly occur above 50 years and regional anesthesia could be a complement in the perioperative treatment of the patients. The use of pericapsular nerve group block (PENG Block) has been proposed to reduce pain. However, no studies have explored the efficient of the systemic analgesia associated with PENG Block in functional limitation in the preoperative period. In this sense, the main goal of this study was to evaluate the effectiveness of systemic analgesia associated with PENG Block in patients with proximal femoral fractures in the period preceding the surgical procedure. Focus on functional capacity measured by the Activity Measure for Post-Acute Care (AM-PAC) short version of the “6 Clicks”, pain intensity assessed using the numerical rating scale, and opioid consumption. Methods: This study included 21 patients admitted to the Emergency Room with proximal femoral fractures. Results: There was an increase in the AM-PAC score obtained 12 hours after the PENG block compared to the pre-block evaluation; specifically, on turning over in bed; sitting down and getting up from a chair with arms; moving from lying on your back to sitting; moving from bed to chair and vice versa; and walking in the hospital room. Also, 1 and 12 hours after the PENG block there was a decreased in pain levels. Conclusions: It is believed that the results of this study can guide the implementation of the PENG block in the preoperative period of fracture of the femur for reducing functional limitations and relieving pain, consequently, allowing the performance of diagnostic tests and guiding the surgical treatment.

Femoral nerve block

Sitting

Acute Pain

10.29011/2574-7754.101442

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Cetamina, sulfato de magnésio e clonidina: passado, presente e futuro

Raquel Chacon Ruiz Martinez Márcio Matsumoto

10.5935/978-85-514-1171-1.c0004

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One year follow-up on a randomized study investigating serratus anterior muscle and pectoral nerves type I block to reduced neuropathic pain descriptors after mastectomy

Scientific Reports (2023)

Eva M. Flores Flavia Venetucci Gouveia Márcio Matsumoto Tomás H. F. S. Bonacif Mayra Akemi Kuroki

Abstract Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anesthesia reduced acute postoperative pain. The present report describes a prospective follow-up study of this published study to investigate the development of chronic neuropathic pain 12 months after mastectomy by comparing the use of general anesthesia alone and general anesthesia with SAM + PECS I. Additionally, the use of analgesic medication, quality of life, depressive symptoms, and possible correlations between plasma levels of interleukin (IL)-1 beta, IL-6, and IL-10 collected before and 24 h after surgery as predictors of pain and depression were evaluated. The results showed that the use of SAM + PECS I with general anesthesia reduced numbness, hypoesthesia to touch, the incidence of patients with chronic pain in other body regions and depressive symptoms, however, did not significantly reduce the incidence of chronic neuropathic pain after mastectomy. Additionally, there was no difference in the consumption of analgesic medication and quality of life. Furthermore, no correlation was observed between IL-1 beta, IL-6, and IL-10 levels and pain and depression. The combination of general anesthesia with SAM + PECS I reduced the occurrence of specific neuropathic pain descriptors and depressive symptoms. These results could promote the use of SAM + PECS I blocks for the prevention of specific neuropathic pain symptoms after mastectomy. Registration of clinical trial: The Research Ethics Board of the Hospital Sirio-Libanes/Brazil approved the study (CAAE 48721715.0.0000.5461). This study is registered at Registro Brasileiro de Ensaios Clinicos (ReBEC), and ClinicalTrials.gov, Identifier: NCT02647385.

Pectoral muscle

10.1038/s41598-023-31589-6

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Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia

Scientific Reports (2018)

Márcio Matsumoto Eva M. Flores Pedro Paulo Kimachi Flavia Venetucci Gouveia Mayra Akemi Kuroki

Abstract Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.

Modified Radical Mastectomy

10.1038/s41598-018-26273-z

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Recommendations for local-regional anesthesia during the COVID-19 pandemic

Brazilian Journal of Anesthesiology (English Edition) (2020)

Rodrigo Moreira e Lima Leonardo de Andrade Reis Felipe Souza Thyrso de Lara Lino Correa Dias Márcio Matsumoto

Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the post-operative period and provides safety to patients and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance. Desde o início da pandemia de COVID-19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID-19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção desta técnica anestésica minimiza os efeitos adversos no pós-operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID-19 e oferecer recomendações práticas para sua realização segura e eficiente.

Pandemic

2019-20 coronavirus outbreak

10.1016/j.bjane.2020.06.002

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Recomendações para realização de anestesia loco‐regional durante a pandemia de COVID‐19

Brazilian Journal of Anesthesiology (2020)

Rodrigo Moreira e Lima Leonardo de Andrade Reis Felipe Souza Thyrso de Lara Lino Correa Dias Márcio Matsumoto

Desde o início da pandemia de COVID‐19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID‐19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção dessa técnica anestésica minimiza os efeitos adversos no pós‐operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID‐19 e oferecer recomendações práticas para sua realização segura e eficiente. Since the beginning of the COVID‐19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID‐19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra‐indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID‐19 and offer practical recommendations for safe and efficient performance.

Pandemic

10.1016/j.bjan.2020.05.002

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Cross-cultural adaptation and content validity evidence of the Brazilian version of the Nociception Coma Scale-revised

Brazilian Journal Of Pain (2020)

Mariana Bucci Sanches Cristiane Vias França Silva Yasmin Mohamed Ali Márcio Matsumoto João Valverde Filho

Content Validity

Content (measure theory)

Cross-Cultural

10.5935/2595-0118.20200180

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The clinical and laboratorial evaluation of transdermal ketamine, fentanyl, clonidine or their combination in chronic low back pain

Coluna/Columna (2009)

Gabriela Rocha Lauretti Márcio Matsumoto Anita L. Mattos Vera Lúcia Lanchote Newton Lindolfo Pereira

OBJECTIVES: chronic low back pain may result in central sensitization, with involvement of different receptors. The aim of this study was to evaluate the analgesic action of transdermal (T) ketamine (a NMDA antagonist), clonidine (an α2-agonist), fentanyl (an opioid agonist), or their combination in chronic low back pain. METHODS: after the institutional approval and informed consent signature, 54 patients were prospectively randomized into 6 groups. Each patient had two of the T preparations applied in different arms. The effect of either T ketamine (1 mg/h), T clonidine (25 µg/h) or T fentanyl (25 µg/h), combined with T placebo (CloG, KetG and FenG); or the combination of T ketamine and clonidine (Ket-CloG), T fentanyl and ketamine (Fen-KetG), or T fentanyl and clonidine (Fen-CloG) was searched for pain and adverse effects. Pain was evaluated by: 1) VAS pain scores, and 2) noradrenaline plasma levels at 0-h (just prior to T application), 3- and 6-h after the T application of two medications, by HPLC. RESULTS: clinically, the pain VAS score at 6-h was smaller in comparison to the 0-h in all groups (p<0.02), and lower when compared to the Fen-CloG and Fen-KetG at the 6-h in relation to the administration of each correspondent T drug alone (p<0.05). The laboratorial data revealed that administration of T fentanyl alone (FenG) resulted in plasma noradrenaline decrease at 6-h (p<0.01), while the association of T fentanyl with clonidine resulted in plasma noradrenaline decrease at 3- and 6-h as compared to the others (p<0.01). The combination of both T ketamine and clonidine (Ket-CloG) did not result in a better analgesic profile and resulted in excessive sedation during the evaluation (p<0.02). CONCLUSIONS: all the studied drugs resulted in clinical analgesia (VAS) at 6-h. However, T fentanyl analgesia was corroborated by lower plasma noradrenaline levels at 6-h when applied alone or at 3-h when combined with T clonidine.

10.1590/s1808-18512009000400016

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Regional anesthesia overview: historical aspects, dissemination, and safety

Perioperative Anesthesia Reports (2023)

Pedro Paulo Kimachi Márcio Matsumoto Raquel Chacon Ruiz Martinez

Regional anesthesia has been widely debated in the literature. This article presents a brief historical overview of regional anesthesia, including critical aspects for its dissemination. In addition, local anesthetics with less neuro and cardiotoxicity and techniques initially guided by electrical stimulation, later followed by ultrasound-guided regional anesthesia, are discussed. Finally, the main recommendations for safety are considered.

Cardiotoxicity

10.61724/par.000423

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Citations (1)