JOSE OSVALDO BARBOSA NETO
Projetos de Pesquisa
Unidades Organizacionais
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
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bookPart Epidemiologia e taxonomia da dor(2019) GARCIA, João Batista Santos; MORAES, Érica Brandão de; BARBOSA NETO, José Osvaldo- Influence of androgenic blockade with flutamide on pain behaviour and expression of the genes that encode the NaV1.7 and NaV1.8 voltage-dependent sodium channels in a rat model of postoperative pain(2019) BARBOSA NETO, Jose Osvaldo; GARCIA, Joao Batista Santos; CARTAGENES, Maria do Socorro de Souza; AMARAL, Andressa Godoy; ONUCHIC, Luiz Fernando; ASHMAWI, Hazem AdelBackgroundExperimental studies suggest that testosterone reduces the nociceptive response after inflammatory and neuropathic stimuli, however the underlying mechanisms have not been fully elucidated. The aims of this study were to evaluate the effect of peripheral blockade of testosterone on pain behaviour and on expression levels of the genes that encode the NaV1.7 and NaV1.8 channels, in dorsal root ganglia in an acute postoperative pain model, as well as the influence of androgen blockade on the expression of these genes.MethodsPostoperative pain was induced by a plantar incision and the study group received flutamide to block testosterone receptor. The animals were submitted to behavioural evaluation preoperatively, 2h after incision, and on the 1st, 2nd, 3rd and 7th postoperative days. Von Frey test was used to evaluate paw withdrawal threshold after mechanical stimuli and the guarding pain test to assess spontaneous pain. The expression of the genes encoding the sodium channels at the dorsal root ganglia was determined by real time quantitative polymerase chain reaction.ResultsAnimals treated with flutamide presented lower paw withdrawal threshold at the 1st, 2nd, 3rd, and 7th postoperative days. The guarding pain test showed significant decrease in the flutamide group at 2h and on the 3rd and 7th postoperative days. No difference was detected between the study and control groups for the gene expression.ConclusionsOur data suggest an antinociceptive effect of androgens following plantar incision. The expression of genes that encode voltage-gated sodium channels was not influenced by androgen blockade.
- Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study(2014) SOUSA, Angela Maria; SANTANA NETO, Jose de; GUIMARAES, Gabriel M. N.; CASCUDO, Giovana M.; NETO, Jose Osvaldo B.; ASHMAWI, Hazem A.The WHO analgesic ladder supports medication choice according to pain intensity. The use of the analgesic ladder in an inverse way, has the advantage of using the same principles of the original ladder to treat crisis of pain in cancer patients. The purpose of this study is to describe the use of intravenous patient-controlled analgesia (IV-PCA) technique in patients admitted to an oncological Hospital. This is a case series study. Patients assigned to receive IV-PCA between March 2011 and May 2012 were selected for the study. Medical records were reviewed, patients stratified according to the Karnofsky Performance Score (KPS). The primary outcome was to verify if different IV-PCA opioid solutions could be equally effective providing pain relief. Secondary outcomes were the incidence of clinical side effects that can be associated to IV-PCA infusions. A total of 95 medical records were reviewed. Most patients used IV-PCA with morphine (42.1 %), fentanyl (42.1 %) or methadone (15.7 %) to treat exacerbation periods of cancer pain. IV-PCA used as supplementary therapy successfully improved pain control in 78.9 % of the patients, without any difference related to opioid solution. KPS < 40 was related to higher rate of pain relief, without any difference in side effects in this group of patients. The most common side effects were sedation (10.5 %) followed by constipation (9.4 %) and nausea (4.2 %). Morphine presented a higher risk than fentanyl for sedation. Analgesia-related delirium or respiratory depression were not reported in this case series study. IV-PCA provided timely, safe and useful analgesia for patients with severe breakthrough pain and may be useful to help titration of opioids, weaning to oral analgesia and to decide for interventional procedures.
- Bloqueio do sistema nervoso simpático para tratamento de dor do membro fantasma: relato de caso(2013) MORAES, Marcos Fernando Breda de; BARBOSA NETO, José Osvaldo; VANETTI, Thaís Khouri; MORAIS, Luciana Chaves de; SOUSA, Ângela Maria; ASHMAWI, Hazem AdelBACKGROUND AND OBJECTIVES: Phantom limb sensation is a phenomenon affecting patients submitted to amputation of any limb and this sensation may or may not be followed by pain. This report aimed at presenting a case where sympathetic nervous system block was used as adjuvant to control phantom limb pain. CASE REPORT: Patient with wrist epidermoid carcinoma, who evolved with phantom limb pain after left forearm amputation. Patient was submitted to conservative treatment and physical rehabilitation, however drug therapy analgesia was insufficient and patient evolved with pain in the amputation stump and sympathetic nervous system-mediated pain. Ultimately, patient was submitted to sympathetic venous block followed by diagnostic chest sympathetic chain block with significant pain decrease. CONCLUSION: Sympathetic nervous system block in this case was induced with venous lidocaine infusion, followed by chest sympathetic chain block as therapeutic option for phantom limb pain. This sequence has provided pain relief without adverse effects.
- Bloqueio neurolítico subaracnoideo em paciente com dor oncológica refratária: relato de caso(2013) BARBOSA NETO, José Osvaldo; SOUSA, Ângela Maria; TAHANTAMI, Silvia Maria Machado; ASHMAWI, Hazem AdelBACKGROUND AND OBJECTIVES: The use of subarachnoid neurolytic blockade to control pain has decreased in recent years due to the introduction of new techniques, but it is still important to control refractory cancer pain. This study aimed at presenting a case of cancer pain where this technique was used to control pain. CASE REPORT: Male patient, 45 years old, with locally advanced anal canal scamous cell carcinoma and ulcerated lesion in perineal region with enterovesical fistula and local infection. Patient had severe pain with numerical verbal scale (NVS) = 10 and was being pharmacologically treated with high opioid doses and adjuvants without good response. Subarachnoid neurolytic blockade was induced with 5% phenol with significant pain relief; 20 minutes after the procedure patient has referred 80% relief. Improvement has remained for 21 days when patient died due to infectious complications. CONCLUSION: This case has illustrated the use of subarachnoid blockade with 5% phenol to control cancer pain. The conclusion is that for selected cases, where life expectation is limited, this technique may be successfully used.
- Dores neuropáticas centrais(2016) GARCIA, João Batista Santos; BARBOSA NETO, José Osvaldo; AMÂNCIO, Edson José; ANDRADE, Erich Talamoni Fonoff deABSTRACT BACKGROUND AND OBJECTIVES: Central pain, classified as neuropathic, is defined as a painful syndrome caused by injury to central nervous system structures. This is one of the most complexes, intriguing and difficult to treat syndromes. This study aimed at promoting a narrative review including the concept of central pain, its intercurrent symptoms which are important for the diagnosis, and different available treatments, indications, results and complications. CONTENTS: Relevant articles available in Medline, Scielo, Cochrane Library and Pubmed databases in the last 10 years were selected by means of keywords: chronic neuropathic pain, central neuropathic pain, central pain. CONCLUSION: Central painful syndrome is diagnosed by means of neurological clinical evaluation. It is often refractory to clinical and neuromodulatory treatment, its management should be multimodal and allow for rehabilitation.
- Hemostatic Resuscitation in Traumatic Hemorrhagic Shock: Case Report(2013) BARBOSA NETO, Jose Osvaldo; MORAES, Marcos Fernando Breda de; NANI, Ricardo Souza; ROCHA FILHO, Joel Avancini; CARMONA, Maria Jose CarvalhoBackground and objectives: The aim of this paper is to report a case in which the damage control resuscitation (DCR) approach was successfully used to promote hemostatic resuscitation in a polytraumatized patient with severe hemorrhagic shock. Case report: Female patient, 32 years of age, with severe hemorrhagic shock due to polytrauma with hip fracture, who developed acidosis, coagulopathy, and hypothermia. During fluid resuscitation, the patient received blood products transfusion of fresh frozen plasma/packed red blood cells/platelet concentrate at a ratio of 1:1:1 and evolved intraoperatively with improvement in perfusion parameters without requiring vasoactive drugs. At the end of the operation, the patient was taken to the intensive care unit and discharged on the seventh postoperative day. Conclusion: The ideal management of traumatic hemorrhagic shock is not yet established, but the rapid control of bleeding and perfusion recovery and well-defined therapeutic protocols are fundamental to prevent progression of coagulopathy and refractory shock.
- Methadone patient-controlled analgesia for postoperative pain: a randomized, controlled, double-blind study(2014) BARBOSA NETO, Jose Osvaldo; MACHADO, Maria Deneb Tavares; CORREA, Marta de Almeida; SCOMPARIM, Hamilton Alves; POSSO, Irimar Paula; ASHMAWI, Hazem AdelPostoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA. This was a randomized, double-blind, controlled, parallel-group study. Patients were randomized into two groups: group methadone-methadone PCA, and group morphine-morphine PCA, for postoperative analgesia. Drugs were delivered through PCA pumps throughout the first 24 h after surgery (T1:6, T2:12, T3:18, T4:24 h). Opioid consumption in 24 h was significantly lower for group methadone than for group morphine. Group methadone patients experienced significantly less pain than group morphine at rest. Pain after movement was significantly lower in group methadone at T1 and T3 and marginally lower at T2 and T4. Adverse events more frequently reported were sleepiness, nausea, and vomiting, but no statistical difference between groups was found. This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA.