{"id":38234,"date":"2022-07-15T11:06:28","date_gmt":"2022-07-15T11:06:28","guid":{"rendered":"https:\/\/www.elza-institute.com\/?p=38234"},"modified":"2024-07-15T09:21:08","modified_gmt":"2024-07-15T09:21:08","slug":"new-and-improved-better-pain-management","status":"publish","type":"post","link":"https:\/\/www.elza-institute.com\/pt\/new-and-improved-better-pain-management\/","title":{"rendered":"Publica\u00e7\u00e3o de um melhor protocolo de tratamento da dor"},"content":{"rendered":"
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Esta semana foi publicado o livro\u00a0O melhor protocolo de gest\u00e3o da dor da ELZA no Journal of Clinical Medicine<\/a>e representa um avan\u00e7o significativo na forma como a dor \u00e9 gerida nos primeiros dias ap\u00f3s epi-off CXL<\/a> e TransPRK<\/a>.<\/p>

A raz\u00e3o pela qual os doentes necessitam de tomar col\u00edrios analg\u00e9sicos ap\u00f3s estes procedimentos \u00e9 o facto de ambos envolverem a remo\u00e7\u00e3o de algumas das c\u00e9lulas epiteliais na parte superior da c\u00f3rnea antes de o estroma - a camada por baixo - ser tratado. As c\u00e9lulas epiteliais voltam a crescer nos dias seguintes, mas durante este per\u00edodo, a menos que os doentes tomem os col\u00edrios para controlo da dor que lhes foram receitados, podem sentir dor e inflama\u00e7\u00e3o. Ningu\u00e9m quer que os doentes sintam dores, por isso damos aos doentes os melhores col\u00edrios analg\u00e9sicos dispon\u00edveis.<\/p>

Se tiver uma dor de cabe\u00e7a, pode tomar um comprimido de ibuprofeno para aliviar a dor. O ibuprofeno \u00e9 um exemplo de um medicamento anti-inflamat\u00f3rio n\u00e3o esteroide (AINE) - reduz a inflama\u00e7\u00e3o que est\u00e1 a causar a dor. Estes medicamentos s\u00e3o \u00f3ptimos analg\u00e9sicos quando tomados sob a forma de comprimido, e tamb\u00e9m s\u00e3o \u00f3ptimos analg\u00e9sicos quando administrados como col\u00edrio nos olhos. No entanto, h\u00e1 uma raz\u00e3o para muitos cirurgi\u00f5es refractivos n\u00e3o oferecerem col\u00edrios de AINE ap\u00f3s a cirurgia: efeitos secund\u00e1rios. Estes podem diminuir a velocidade a que as c\u00e9lulas epiteliais se regeneram e, em ocasi\u00f5es muito raras, podem causar a forma\u00e7\u00e3o de \u00falceras graves na c\u00f3rnea, conhecidas como derretimentos da c\u00f3rnea.<\/p>

O Prof. Hafezi e os seus co-autores colocaram duas quest\u00f5es. A primeira era: porqu\u00ea? A segunda era: podemos fazer alguma coisa em rela\u00e7\u00e3o a isso? Se pudermos utilizar os AINE com seguran\u00e7a nos primeiros dias ap\u00f3s a cirurgia, podemos proporcionar aos doentes a melhor qualidade poss\u00edvel de al\u00edvio da dor.<\/p>

Para responder \u00e0 primeira pergunta, tivemos de ver como \u00e9 que os medicamentos AINE funcionam. Estes actuam bloqueando uma enzima chamada ciclo-oxigenase, que converte mol\u00e9culas presentes na membrana de todas as c\u00e9lulas, chamadas fosfol\u00edpidos, em mol\u00e9culas que causam inflama\u00e7\u00e3o e, consequentemente, dor. No entanto, isto significa que mais fosfol\u00edpidos seguem uma via diferente: a via da 5-lipoxigenase, o que resulta na regula\u00e7\u00e3o positiva das enzimas - metaloproteinases da matriz - que digerem as prote\u00ednas, o que explica o risco potencial de derretimento.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Isto revela a resposta \u00e0 segunda pergunta: podemos fazer alguma coisa? O ideal seria utilizar um inibidor t\u00f3pico da 5-lipoxigenase ao mesmo tempo que um AINE - mas n\u00e3o existe nenhum medicamento desse g\u00e9nero. No entanto, existe uma classe de medicamentos que pode inibir ambas as vias: os ester\u00f3ides. Empiricamente, a combina\u00e7\u00e3o de AINEs com ester\u00f3ides deve significar que podemos obter um grande al\u00edvio da dor com AINEs, sem os inconvenientes dos AINEs. Foi isto que Jerry Tan e Shady Awwad propuseram e, durante muitos anos, utilizaram este regime nas suas cl\u00ednicas para proporcionar aos doentes um melhor controlo da dor ap\u00f3s a cirurgia TransPRK ou epi-off CXL. O que o Instituto ELZA fez foi examinar formalmente os resultados de todos os doentes que receberam este protocolo de dor durante um per\u00edodo de 7 anos, apenas para se certificar de que n\u00e3o havia qualquer indica\u00e7\u00e3o de atraso na cicatriza\u00e7\u00e3o das c\u00e9lulas epiteliais ou, pior ainda, de fus\u00e3o da c\u00f3rnea, com esta abordagem. E em 877 pacientes, foi exatamente isso que encontr\u00e1mos.<\/p>

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Clicar aqui<\/a> para ler o documento:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\"\"\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

This week saw the publication of\u00a0ELZA’s better pain management protocol in the Journal of Clinical Medicine, and represents a significant advance in the way pain is managed in the first few days after epi-off CXL and TransPRK. 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