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Mémoire de Maîtrise
DOI
https://doi.org/10.11606/D.17.2020.tde-12022020-172447
Document
Auteur
Nom complet
Adriana de Oliveira Machado Peixoto
Adresse Mail
Unité de l'USP
Domain de Connaissance
Date de Soutenance
Editeur
Ribeirão Preto, 2019
Directeur
Jury
Lauretti, Gabriela Rocha (Président)
Engel, Edgard Eduard
Abrão, João
Barros, Guilherme Antonio Moreira de
Titre en portugais
Avaliação do efeito antinociceptivo da ablação neuropática e autonômica por Radiofrequência em pacientes portadores de dor cervicobraquial crônica Síndrome Dolorosa Complexa Regional do Tipo-I
Mots-clés en portugais
Analgesia
Bloqueio de gânglio estrelado
Dor crônica
Radiofrequência
Síndrome Dolorosa Complexa Regional
Resumé en portugais
A Síndrome Dolorosa Complexa Regional-tipo I (SDCR-I) é uma condição clínica dolorosa que manifesta-se com alterações no sistema sensorial, vaso/sudomotor e somático. O tratamento dos casos refratários é baseado em bloqueios intervencionistas dos componentes autonômico e neuropático. O objetivo deste estudo é avaliar o efeito antinociceptivo, a durabilidade e o custo financeiro da ablação por radiofrequência do gânglio estrelado em pacientes portadores de SDCR-I comparada à terapia convencional, durante o período de 12 meses. O estudo foi prospectivo e foram selecionados 10 pacientes, cada um atuando como seu próprio controle e com duração aproximada de 12 meses. Os pacientes foram atendidos no CTDor-HC-FMRP-USP, com SDCR-I, submetidos ao protocolo de tratamento intervencionista deste serviço. Realizados bloqueios testes positivos, procedeu-se às ablações por Radiofrequência (RF) e avaliou-se o tempo de analgesia, a qualidade de sono, a capacidade de realização de atividades rotineiras e os custos anuais com as duas técnicas. Nos pacientes submetidos ao bloqueio teste, o tempo de analgesia foi de 3-4 meses, enquanto após RF foi de 12-13 meses. A qualidade de sono durante o período de analgesia adequada apresentou melhora de 55%, comparada à inadequada. O mesmo aconteceu com a capacidade para realização de atividades rotineiras diárias. Em relação aos custos, houve redução de 23% no primeiro ano. Os bloqueios por RF na SDCR-I resultaram em efetividade analgésica, padrão de sono noturno e capacidade para realização de atividades físicas semelhantes ao bloqueio teste convencional. Contudo, observou-se maior durabilidade e redução dos custos financeiros
Titre en anglais
Evaluation of the antinociceptive effect of the ablation neuropathic and autonomic by radiofrequency in patients with pain cervicobraquial chronic Complex Regional Pain Syndrome Type-I
Mots-clés en anglais
Analgesia
Chronic pain
Complex Regional Pain Syndrome
Ganglion blockage
Radiofrequency
Resumé en anglais
Complex Regional Pain Syndrome Type-I (CRPS-I) is a painful condition that presents clinical alterations in the sensory system, vasomotor/sudomotor and somatic, disproportionate to the triggering event. It is often results from a surgical complication or trauma, however it may also present spontaneous development. It is often located at only one limb and there is a variable progression. The treatment of refractory cases is based on autonomic blockades associated with neuropathic blockade, both performed sequentially. The aim of this study is to evaluate the antinociceptive effect, durability and financial cost of radiofrequency ablation of neuropathic tissue and sympathetic ganglion in patients with CRPS-I compared to conventional therapy over a period of approximately one year. The study was prospective and 12 patients were randomly selected and each patient acted as their own control. The duration of the study was approximately 12 months. The patients were treated at the CTDor-HC-FMRP-USP, with a history of CRPS-I patients with chronic neuropathic and autonomic pain, who were submitted to the protocol of interventional treatment of this service and to the use of drugs to control pain. Positive blockage tests were performed, Radiofrequency ablation (RF) was performed in a operating room guided by c-arm. The time of analgesia, the quality of sleep, the ability to perform routine activities and the annual costs for both techniques were then evaluated. In the patients undergoing the test block, the time of analgesia (VAS <4 cm) was 3-4 months, while after RF it was 13 months. The sleep quality of the VAS (0-10 cm) during the period of adequate analgesia showed improvement of 55% compared to inadequate analgesia. The same was true of the ability to perform routine daily activities. In relation to financial costs, there was a reduction of 23% in the first year, reaching up to 35% when prospecting the costs in 10 years of treatment. RF blockade in the CRPS-I resulted in analgesic effectiveness, nocturnal sleep pattern and ability to perform physical activities similar to the conventional test block. However, longer durability and reduction of financial costs were observed in 12 months
 
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Date de Publication
2020-03-17
 
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