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Doctoral Thesis
DOI
10.11606/T.5.2013.tde-02012014-174753
Document
Author
Full name
João Eduardo Daud Amadera
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2013
Supervisor
Committee
Hsing, Wu Tu (President)
Negri, Elnara Márcia
Azevedo Neto, Raymundo Soares de
Buehler, Anna Maria
Lima, John Paul Hempel
Title in Portuguese
Avaliação do tratamento da dor crônica em ombros de hemiplégicos com bloqueio transforaminal de C6: um estudo duplo cego randomizado sham-controlado
Keywords in Portuguese
Acidente vascular cerebral
Dexametasona
Dor
Dor crônica/etiologia
Dor crônica/fisiopatologia
Dor crônica/patologia
Dor de ombro/fisiopatologia
Dor de ombro/patologia
Dor de ombro/terapia
Ensaio clínico controlado aleatório
Hemiplegia/fisiopatologia
Limiar da dor/fisiologia
Placebos
Sensibilização do sistema nervoso central
Abstract in Portuguese
Objetivo: A taxa de falha terapêutica para dor crônica em ombros de hemiplégicos (DOH) pós acidente vascular encefálico (AVE) é significante. Diversas abordagens terapêuticas têm sido propostas, porém os resultados dos estudos que as têm investigado demostram resultados controversos. Objetivo: Elaborar um protocolo para avaliar a eficácia da injeção de dexametasona via transforaminal (TF) na DOH. Métodos: Ensaio clínico randomizado, controlado por placebo, com cegamento de pacientes e avaliadores de desfecho. Ambiente clínico: Departamento de Ortopedia e Neurocirurgia de um hospital terciário. Participantes: Pacientes (N = 38) com DOH refratária ao tratamento conservador e escore de dor em repouso superior a quatro centímetros na escala visual analógica de dor (EVA) de 0 a 10 centímetros. Intervenção: TF no nível C5-C6. Comparador: Intervenção sham. Medida de desfecho principal: Variação na EVA três meses após a intervenção. Seguimento: As avaliações foram realizadas imediatamente antes, uma semana após e três meses depois das intervenções. Resultados: TF com dexametasona reduziu significantemente a intensidade da dor quando comparado com o grupo sham (p < 0,001). Adicionalmente, a Medida de Independência Funcional, a algometria do músculo trapézio, a algometria dos dermátomos de C4 e C5 e a algometria dos ligamentos interespinhosos de C6-7 e C7-T1 melhoraram ao término do tratamento no grupo TF (p < 0,05). Não foram relatados efeitos colaterais significantes. Conclusões: TF com dexametasona demonstrou ser eficaz no alívio da dor no ombro em pacientes pós-AVE quando comparado com placebo. Ensaios clínicos maiores são necessários para confirmar esses achados
Title in English
Transforaminal epidural steroid injection to treat hemiplegic shoulder pain: a randomized, double-blind, sham-controlled trial
Keywords in English
Anesthesia epidural
Central nervous system sensitizaiton
Dexamethasone
Dor de ombro/physiopathology
Dor de ombro/therapy
Hemiplegy/physiopathology
Pain
Pain treshold/psysiology
Placebos
Randomized controlled trial
Shoulder pain/etiology
Shoulder pain/pathology
Shoulder pain/physiopathology
Stroke
Abstract in English
Objective: Because of the lack of effective treatment today for hemiplegic shoulder pain (HSP) we designed a protocol to evaluate the efficacy of transforaminal epidural dexamethasone injection (TFESI) in relieving it. Design: A randomized, blind, sham-controlled trial with assessments before and after TFESI. Setting: Orthopedics and Neurosurgery department of a tertiary hospital. Participants: Patients (N=38) with HSP refractory to standard treatments and pain score at rest greater than 4cm on a pain visual analog scale (VAS) of 0 to 10cm. Intervention: TFESI at the C5-6 level. Main Outcome Measure: Variation in VAS score 3 months after interventions. Methods: We performed a randomized, sham-controlled, double blind clinical trial in which 38 patients were randomized to receive TFESI ("TFESI" group) or sham ("sham" group). Assessments were performed immediately before, 1 week after and 3 months after by a blinded rater. Results: At baseline, groups did not differ regarding any of the outcome variables. After 3 months pain intensity was significantly better in the TFESI group as compared to Sham (p < 0.05). For the secondary outcome measures, the functional independency, the algometry of the trapezius muscle and at the C4 and at the C5 levels and the algometry of the ligment at the C6-7 and at the C7-T1 levels also improved after the TFESI treatment (p < 0.05). No side effects were found. Conclusions: TFESI is effective for pain relief and functional independency in patients with HSP. The results of this study suggest that TF has a superior effect compared with Sham intervention. Larger randomized controlled trials should be made to confirm efficacy of TFESI in patients with refractory HSP
 
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Publishing Date
2014-01-03
 
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