Áurea Maria Oliveira da Silva

Transcutaneous electrical nerve stimulation in the relief of pain related to physical therapy after abdominal surgery

BACKGROUND AND OBJECTIVES There are few studies on transcutaneous electrical stimulation (TENS) as an adjunct to postoperative physical therapy. The objective of this study was to determine the efficacy of TENS on relieving pain related to physical therapy after abdominal surgery. METHODS A clinical, randomized, prospective study was undertaken with 48 patients on the first postoperative day, who presented a pain score > 3 on the visual analogic scale (VAS). Patients were divided in three groups: CONTROL GROUP treated with the usual analgesic routine, without TENS, and with physical therapy; STUDY GROUP treated with the usual analgesic routine associated with TENS and physical therapy; Contrast-Placebo Group: treated with the usual analgesic routine associated with physical therapy but TENS was off. A visual analogic scale of pain was presented to the patients before (M1), after TENS (M2), and after physical therapy (M3) - cough, incentive spirometry, changing lateral decubitus and sitting - to quantify the efficacy of the analgesia. Electrical stimulation was done during 30 minutes. RESULTS The STUDY GROUP presented a significant relief of the pain when compared to the other two groups only for coughing at M3 (p= 0.015). In this group, there was a significant reduction in pain associated with coughing (p= 0.003) [M1 versus M3]; with lateral decubitus (p= 0.025), sitting (p= 0.001), and with incentive spirometry (p= 0.017) [M1 versus M2]; and when changing to the lateral decubitus (p= 0.03) and sitting (p= 0.001) [M1xM3]. There were no significant differences in the Contrast-Placebo Group. CONCLUSIONS The STUDY GROUP presented a reduction in pain in a few moments and parameters. Further studies are needed since TENS is indicated only as an adjuvant in controlling postoperative pain.JUSTIFICATIVA Y OBJETIVOS: LA electroestimulacion nerviosa transcutanea (TENS) ha sido poco estudiada como metodo facilitador de la fisioterapia postoperatoria. El objetivo del estudio fue el de verificar la eficacia de la TENS en el alivio del dolor relacionado a la fisioterapia postoperatoria en pacientes sometidos a intervenciones quirurgicas abdominales. METODO: Se realizo un estudio clinico, prospectivo, con distribucion aleatoria, incluyendo 48 pacientes en el 1o dia de postoperatorio, que presentaban un puntaje de dolor > 3 puntos en la escala visual analogica (VAS), divididos en tres grupos: Grupo Control: con rutina analgesica habitual, sin TENS y con fisioterapia; Grupo Estudio, recibiendo rutina analgesica habitual mas TENS, y fisioterapia; Grupo Contraste-Placebo, recibiendo rutina analgesica habitual, fisioterapia y TENS desvinculada. Se presento a los pacientes una escala visual analogica de dolor antes (M1), despues de la TENS (M2) y despues de la fisioterapia (M3) - tos, incentivador respiratorio, cambio de decubito lateral y sentado - cuantificando la efectividad de la analgesia. El tiempo de electroestimulacion fue de 30 minutos. RESULTADOS: Hubo un alivio significativo del dolor en el Grupo Estudio, comparandolo con los tres grupos, apenas para el procedimiento tos, en el M3 (p = 0,015). Dentro de ese grupo hubo una disminucion significativa del dolor para tos (p = 0,003) [M1 versus M3]; para decubito lateral (p = 0,025), sentarse (p = 0,001) y utilizar el incentivador inspiratorio (p = 0,017) [M1 versus M2]; y al cambiar para decubito lateral (p = 0,03) y sentarse (p = 0,001) [M1xM3]. No hobo diferencia significativa en el Grupo Contraste Placebo. CONCLUSIONES: Hubo disminucion del dolor en el Grupo Estudio, en algunos momentos y parametros. Estudios adicionales se hacen necesarios, ya que la utilizacion de la TENS esta indicada apenas como coadyuvante en el control del dolor postoperatorio.

Estimulação elétrica nervosa transcutânea no alívio da dor pós-operatória relacionada com procedimentos fisioterapêuticos em pacientes submetidos a intervenções cirúrgicas abdominais

BACKGROUND AND OBJECTIVES There are few studies on transcutaneous electrical stimulation (TENS) as an adjunct to postoperative physical therapy. The objective of this study was to determine the efficacy of TENS on relieving pain related to physical therapy after abdominal surgery. METHODS A clinical, randomized, prospective study was undertaken with 48 patients on the first postoperative day, who presented a pain score > 3 on the visual analogic scale (VAS). Patients were divided in three groups: CONTROL GROUP treated with the usual analgesic routine, without TENS, and with physical therapy; STUDY GROUP treated with the usual analgesic routine associated with TENS and physical therapy; Contrast-Placebo Group: treated with the usual analgesic routine associated with physical therapy but TENS was off. A visual analogic scale of pain was presented to the patients before (M1), after TENS (M2), and after physical therapy (M3) - cough, incentive spirometry, changing lateral decubitus and sitting - to quantify the efficacy of the analgesia. Electrical stimulation was done during 30 minutes. RESULTS The STUDY GROUP presented a significant relief of the pain when compared to the other two groups only for coughing at M3 (p= 0.015). In this group, there was a significant reduction in pain associated with coughing (p= 0.003) [M1 versus M3]; with lateral decubitus (p= 0.025), sitting (p= 0.001), and with incentive spirometry (p= 0.017) [M1 versus M2]; and when changing to the lateral decubitus (p= 0.03) and sitting (p= 0.001) [M1xM3]. There were no significant differences in the Contrast-Placebo Group. CONCLUSIONS The STUDY GROUP presented a reduction in pain in a few moments and parameters. Further studies are needed since TENS is indicated only as an adjuvant in controlling postoperative pain.JUSTIFICATIVA Y OBJETIVOS: LA electroestimulacion nerviosa transcutanea (TENS) ha sido poco estudiada como metodo facilitador de la fisioterapia postoperatoria. El objetivo del estudio fue el de verificar la eficacia de la TENS en el alivio del dolor relacionado a la fisioterapia postoperatoria en pacientes sometidos a intervenciones quirurgicas abdominales. METODO: Se realizo un estudio clinico, prospectivo, con distribucion aleatoria, incluyendo 48 pacientes en el 1o dia de postoperatorio, que presentaban un puntaje de dolor > 3 puntos en la escala visual analogica (VAS), divididos en tres grupos: Grupo Control: con rutina analgesica habitual, sin TENS y con fisioterapia; Grupo Estudio, recibiendo rutina analgesica habitual mas TENS, y fisioterapia; Grupo Contraste-Placebo, recibiendo rutina analgesica habitual, fisioterapia y TENS desvinculada. Se presento a los pacientes una escala visual analogica de dolor antes (M1), despues de la TENS (M2) y despues de la fisioterapia (M3) - tos, incentivador respiratorio, cambio de decubito lateral y sentado - cuantificando la efectividad de la analgesia. El tiempo de electroestimulacion fue de 30 minutos. RESULTADOS: Hubo un alivio significativo del dolor en el Grupo Estudio, comparandolo con los tres grupos, apenas para el procedimiento tos, en el M3 (p = 0,015). Dentro de ese grupo hubo una disminucion significativa del dolor para tos (p = 0,003) [M1 versus M3]; para decubito lateral (p = 0,025), sentarse (p = 0,001) y utilizar el incentivador inspiratorio (p = 0,017) [M1 versus M2]; y al cambiar para decubito lateral (p = 0,03) y sentarse (p = 0,001) [M1xM3]. No hobo diferencia significativa en el Grupo Contraste Placebo. CONCLUSIONES: Hubo disminucion del dolor en el Grupo Estudio, en algunos momentos y parametros. Estudios adicionales se hacen necesarios, ya que la utilizacion de la TENS esta indicada apenas como coadyuvante en el control del dolor postoperatorio.

A influência do treinamento muscular respiratório pré-operatório na recuperação de pacientes submetidos à esofagectomia

AIM: To correlate the effects of the respiratory muscular training (RMT) in the pre-operative period of esophagectomies, with the post-operative pulmonary complications. METHODS: Forty patients were randomically submitted to two groups: 20 patients with RMT during 5 day/week (1 to 4 weeks pre-operatively) and 20 patients without RMT (control group). PImax, Pemax, pulmonary function test, arterial blood gas analyses and cirtometry data were collected before RMT, at the end of each week of training and in the 7th post-operative day. RMT consisted on bicycle (15 minutes); threshold (15 minutes), CPAP (15 minutes), inspirometer (3 series of 15 repetitions) and ventilatory patterns (3 series of 15 repetitions). All patients were treated by trans-mediastinal esophagectomies. RESULTS: An increase of PEmax (P< 0.05) and PImax (P< 0.05) during the 4 weeks of RMT was found. There was a decrease of PEmax and PImax in both groups in the post-operative period, however, the length on intensive care unit (1-4 days vs 1-17 days) and hospital stay (12-18 days vs 19-46 days) in the trained group was shorter. The respiratory complications were lower in RMT group. CONCLUSION: Respiratory muscular training is important in increasing the respiratory muscles force and endurance and, consequently, better surgical recovery with minor intensive unit and hospital staying.

Chemical pleurodesis for hepatic hydrothorax

BACKGROUND Ascites can occur after hepatic diseases causing dyspnea, coughing and pain. When associated with pleural effusion it can also increase respiratory distress. In a bibliographic survey hydrothorax has been observed in up to 20% of the patients and the kind of treatment is still being discussed. OBJECTIVE This case report shows the occurrence of a large volume of ascites and pleural effusion in a cirrhotic patient and his treatment. METHODS Report the case of a patient with hepatic cirrhosis due to chronic alcoholism and massive pleural effusion and ascites. He was submitted to several pleural paracenteses without success. Scintigraphy showed the presence of ascites and confirmed a possible pleuroperitoneal communication. The thoracic surgery group was called and after evaluation it was decided to submit the patient to a pulmonary decortication and chemical pleurodesis. RESULTS These procedures were carried out with success. The pleural effusion was solved and the treatment of ascites was decided upon because the patient did not accept any surgical procedure. CONCLUSION This treatment could be applied to patients with hydrothorax who could not be submitted to a liver transplantation.

Exercise manual for liver disease patients

AIM To increase inspiratory muscle strength and improve the quality of life of candidates for liver transplantation. METHODS Twenty-three candidates for liver transplantation participated in the control group and 14 made up the intervention group. The control group consisted of 18 men and 5 women, body mass index (BMI) 27.3 ± 4.5 kg/m(2) and Model for End-Stage Liver Disease (MELD) 18.2 ± 6.1. The intervention group consisted of 11 men and 3 women, BMI 28.6 ± 5.4 kg/m(2) and MELD 18 ± 4.5. The presence or absence of ascites was identified in the first patient evaluation and after three months. We evaluated maximal inspiratory pressure (MIP) and maximal expiratory pressure, spirometry, root mean square (RMS) of diaphragm and rectus abdominis, and the quality of life. The exercises were performed daily by patients at home for three months and were supervised at distance monthly. The manual consisted of diaphragmatic breathing exercises, diaphragmatic isometric exercise, Threshold IMT(®), lifting upper limbs with a bat and strengthening the abdomen. RESULTS There was significant difference (P = 0.01) between the first (initial) and the third month (final) MIP in the control group and in the intervention group, but there was no difference (P = 0.45) between the groups. The RMS of the diaphragm was lower (P = 0.001) and the functional capacity was higher (P = 0.006) in the intervention group compared to the control. The general health and mental health domains received higher scores after three months in the control group (P = 0.01) and the intervention group (P = 0.004), but there was no significant difference between them. The comparison between the presence of initial ascites with the presence of ascites was performed after three months in the control group (P = 0.083) and intervention group (P = 0.31). There was no significant difference, in relation to the presence of ascites after three months between groups (P = 0.21). In the intervention group, patients with ascites at the end of the time period had decreased scores on the social aspects SF-36 domain (P = 0.023) compared to those who had no ascites. CONCLUSION The proposed exercises provide an increase in the inspiratory muscle strength and improve functional capacity, consequently bettering the quality of life of liver disease patients.

Estimulación eléctrica nerviosa transcutánea no alivio del dolor postoperatorio relacionado con los procedimientos fisioterapéuticos en pacientes sometidos a intervenciones quirúrgicas abdominales

BACKGROUND AND OBJECTIVES There are few studies on transcutaneous electrical stimulation (TENS) as an adjunct to postoperative physical therapy. The objective of this study was to determine the efficacy of TENS on relieving pain related to physical therapy after abdominal surgery. METHODS A clinical, randomized, prospective study was undertaken with 48 patients on the first postoperative day, who presented a pain score > 3 on the visual analogic scale (VAS). Patients were divided in three groups: CONTROL GROUP treated with the usual analgesic routine, without TENS, and with physical therapy; STUDY GROUP treated with the usual analgesic routine associated with TENS and physical therapy; Contrast-Placebo Group: treated with the usual analgesic routine associated with physical therapy but TENS was off. A visual analogic scale of pain was presented to the patients before (M1), after TENS (M2), and after physical therapy (M3) - cough, incentive spirometry, changing lateral decubitus and sitting - to quantify the efficacy of the analgesia. Electrical stimulation was done during 30 minutes. RESULTS The STUDY GROUP presented a significant relief of the pain when compared to the other two groups only for coughing at M3 (p= 0.015). In this group, there was a significant reduction in pain associated with coughing (p= 0.003) [M1 versus M3]; with lateral decubitus (p= 0.025), sitting (p= 0.001), and with incentive spirometry (p= 0.017) [M1 versus M2]; and when changing to the lateral decubitus (p= 0.03) and sitting (p= 0.001) [M1xM3]. There were no significant differences in the Contrast-Placebo Group. CONCLUSIONS The STUDY GROUP presented a reduction in pain in a few moments and parameters. Further studies are needed since TENS is indicated only as an adjuvant in controlling postoperative pain.JUSTIFICATIVA Y OBJETIVOS: LA electroestimulacion nerviosa transcutanea (TENS) ha sido poco estudiada como metodo facilitador de la fisioterapia postoperatoria. El objetivo del estudio fue el de verificar la eficacia de la TENS en el alivio del dolor relacionado a la fisioterapia postoperatoria en pacientes sometidos a intervenciones quirurgicas abdominales. METODO: Se realizo un estudio clinico, prospectivo, con distribucion aleatoria, incluyendo 48 pacientes en el 1o dia de postoperatorio, que presentaban un puntaje de dolor > 3 puntos en la escala visual analogica (VAS), divididos en tres grupos: Grupo Control: con rutina analgesica habitual, sin TENS y con fisioterapia; Grupo Estudio, recibiendo rutina analgesica habitual mas TENS, y fisioterapia; Grupo Contraste-Placebo, recibiendo rutina analgesica habitual, fisioterapia y TENS desvinculada. Se presento a los pacientes una escala visual analogica de dolor antes (M1), despues de la TENS (M2) y despues de la fisioterapia (M3) - tos, incentivador respiratorio, cambio de decubito lateral y sentado - cuantificando la efectividad de la analgesia. El tiempo de electroestimulacion fue de 30 minutos. RESULTADOS: Hubo un alivio significativo del dolor en el Grupo Estudio, comparandolo con los tres grupos, apenas para el procedimiento tos, en el M3 (p = 0,015). Dentro de ese grupo hubo una disminucion significativa del dolor para tos (p = 0,003) [M1 versus M3]; para decubito lateral (p = 0,025), sentarse (p = 0,001) y utilizar el incentivador inspiratorio (p = 0,017) [M1 versus M2]; y al cambiar para decubito lateral (p = 0,03) y sentarse (p = 0,001) [M1xM3]. No hobo diferencia significativa en el Grupo Contraste Placebo. CONCLUSIONES: Hubo disminucion del dolor en el Grupo Estudio, en algunos momentos y parametros. Estudios adicionales se hacen necesarios, ya que la utilizacion de la TENS esta indicada apenas como coadyuvante en el control del dolor postoperatorio.