IRIMAR DE PAULA POSSO

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Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 20 Citação(ões) na Scopus
    Percutaneous sciatic nerve block with tramadol induces analgesia and motor blockade in two animal pain models
    (2012) SOUSA, A. M.; ASHMAWI, H. A.; COSTA, L. S.; POSSO, I. P.; SLULLITEL, A.
    Local anesthetic efficacy of tramadol has been reported following intradermal application. Our aim was to investigate the effect of perineural tramadol as the sole analgesic in two pain models. Male Wistar rats (280-380 g; N = 5/group) were used in these experiments. A neurostimulation-guided sciatic nerve block was performed and 2% lidocaine or tramadol (1.25 and 5 mg) was perineurally injected in two different animal pain models. In the flinching behavior test, the number of flinches was evaluated and in the plantar incision model, mechanical and heat thresholds were measured. Motor effects of lidocaine and tramadol were quantified and a motor block score elaborated. Tramadol, 1.25 mg, completely blocked the first and reduced the second phase of the flinching behavior test. In the plantar incision model, tramadol (1.25 mg) increased both paw withdrawal latency in response to radiant heat (8.3 +/- 1.1, 12.7 +/- 1.8, 8.4 +/- 0.8, and 11.1 +/- 3.3 s) and mechanical threshold in response to von Frey filaments (459 +/- 82.8, 447.5 +/- 91.7, 320.1 +/- 120, 126.43 +/- 92.8 mN) at 5, 15, 30, and 60 min, respectively. Sham block or contralateral sciatic nerve block did not differ from perineural saline injection throughout the study in either model. The effect of tramadol was not antagonized by intraperitoneal naloxone. High dose tramadol (5 mg) blocked motor function as well as 2% lidocaine. In conclusion, tramadol blocks nociception and motor function in vivo similar to local anesthetics.
  • article 49 Citação(ões) na Scopus
    Sex and Pain Perception and Analgesia
    (2011) PALMEIRA, Claudia Carneiro de Araujo; ASHMAWI, Hazem Adel; POSSO, Irimar de Paula
    Palmeira CCA, Ashmawi HA, Posso IP - Sex and Pain Perception and Analgesia. Sex is an important factor in painful experience modulation. Large volume of evidence shows that experience is different for males and females, as well as the answer to some classes of analgesics. Laboratory experiments suggest that women have a lower pain threshold than men related to pain from noxious stimuli such as heat, cold, pressure and electrical stimulation. Pain is a dynamic phenomenon under the influence of various mechanisms of excitatory and inhibitory control. The differences in pain perception related to sex may be associated with hyperalgesia in women, but also to the hypoactivity of the inhibitory system of pain in females. The purpose of this review besides showing some relationship for gonadal hormones, central nervous system and pain is to provide reference points for the discussion of one of the most intriguing aspects of the pathophysiology of pain: the differences in the presence of painful stimuli related to gender.
  • article 69 Citação(ões) na Scopus
    Prevalence of Chronic Pain, Treatments, Perception, and Interference on Life Activities: Brazilian Population-Based Survey
    (2017) SOUZA, Juliana Barcellos de; GROSSMANN, Eduardo; PERISSINOTTI, Dirce Maria Navas; OLIVEIRA JUNIOR, Jose Oswaldo de; FONSECA, Paulo Renato Barreiros da; POSSO, Irimar de Paula
    Background and Objectives. Chronic pain affects between 30% and 50% of the world population. Our objective was to estimate the prevalence of chronic pain in Brazil, describe and compare differences between pain types and characteristics, and identify the types of therapies adopted and the impact of pain on daily life. Methods. Cross-sectional study of a population-based survey with randomized sample from a private database. The interviews were conducted by phone. 78% of the respondents aged 18 years or more agreed to be interviewed, for a total of 723 respondents distributed throughout the country. Independent variables were demographic data, pain and treatment characteristics, and impact of pain on daily life. Comparative and associative statistical analyses were conducted to select variables for nonhierarchical logistic regression. Results. Chronic pain prevalence was 39% and mean age was 41 years with predominance of females (56%). We found higher prevalence of chronic pain in the Southern and Southeastern regions. Pain treatment was not specific to gender. Dissatisfaction with chronic painmanagement was reported by 49% of participants. Conclusion. 39% of interviewed participants reported chronic pain, with prevalence of females. Gender-associated differences were found in intensity perception and interference of pain on daily life activities.
  • article 7 Citação(ões) na Scopus
    Changes in Purines Concentration in the Cerebrospinal Fluid of Pregnant Women Experiencing Pain During Active Labor
    (2015) SCHMIDT, Andre P.; BOEHMER, Ana E.; HANSEL, Gisele; SOARES, Felix A.; OSES, Jean P.; GIORDANI, Alex T.; POSSO, Irimar P.; AULER JR., Jose Otavio C.; MENDES, Florentino F.; FELIX, Elaine A.; PORTELA, Luis V.; SOUZA, Diogo O.
    Labor pain has been reported as a severe pain and can be considered as a model of acute visceral pain. It is well known that extracellular purines have an important role in pain signaling in the central nervous system. This study analyzes the relationship between extracellular purines and pain perception during active labor. A prospective observational study was performed. Cerebrospinal fluid (CSF) levels of the purines and their metabolites were compared between women at term pregnancy with labor pain (n = 49) and without labor pain (Caesarian section; n = 47). Control groups (healthy men and women without chronic or acute pain-n = 40 and 32, respectively) were also investigated. The CSF levels of adenosine were significantly lower in the labor pain group (P = 0.026) and negatively correlated with pain intensity measured by a visual analogue scale (r = -0.48, P = 0.0005). Interestingly, CSF levels of uric acid were significantly higher in healthy men as compared to women. Additionally, pregnant women showed increased CSF levels of ADP, GDP, adenosine and guanosine and reduced CSF levels of AMP, GTP, and uric acid as compared to non-pregnant women (P < 0.05). These findings suggest that purines, in special the nucleoside adenosine, are associated with pregnancy and labor pain.
  • article 8 Citação(ões) na Scopus
    Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change
    (2016) VALE, Arthur Halley Barbosa do; VIDEIRA, Rogerio Luiz da Rocha; GOMEZ, David Souza; CARMONA, Maria Jose Carvalho; TSUCHIE, Sara Yume; FLORIO, Claudia; VANE, Matheus Fachini; POSSO, Irimar de Paula
    Background and objectives: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. Method: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O-2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O-2 under the same flow (control group). Results: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. Conclusions: The association of N2O was not effective in reducing opioid consumption during dressing changes.
  • article 4 Citação(ões) na Scopus
    Cutaneous Application of Silicone Wafers Containing Carbon Microcoils: Efficacy in Relieving Chronic Muscle Tension and Pain
    (2015) TSUJI, Domingos H.; AWADE, Roberto; POSSO, Irimar Paula
    Background: Chronic musculoskeletal pain is highly prevalent worldwide. Primary study objective: The aim of this study was to evaluate the efficacy of Helical((R)) microcoils, a new, noninvasive treatment for chronic musculoskeletal pain. Design: This was a prospective, observational study. Setting: The study was conducted at the main author's private clinic, in SAo Paulo, Brazil. Participants: We evaluated 20 physicians, from 2 different hospitals, who suffered from chronic musculoskeletal pain and volunteered to participate in the study. Intervention: The Helical((R)) microcoils were applied to the skin over the affected areas. Before and after the intervention, the physician-patients completed questionnaires and a visual analog scale. Primary outcome measures: We quantified postintervention improvement or worsening of pain and muscle tension. Results: Significant improvements in pain and muscle tension were observed in 95% of the physician-patients evaluated. The only side effect reported was mild pruritus at the application site, which occurred in 5 of the 20 cases. Conclusion: The use of Helical microcoils was found to be safe and efficacious in relieving muscle tension and pain.
  • article 44 Citação(ões) na Scopus
    The use of different doses of metamizol for post-operative analgesia in dogs
    (2011) IMAGAWA, Vivianne H.; FANTONI, Denise T.; TATARUNAS, Angelica C.; MASTROCINQUE, Sandra; ALMEIDA, Tatiana F.; FERREIRA, Fernando; POSSO, Irimar P.
    Objective To evaluate the post-operative analgesic effect of metamizol (dipyrone) administered intravenously at three different doses (15 mg kg(-1), 25 mg kg(-1) and 35 mg kg(-1)) compared to placebo in dogs undergoing ovariohysterectomy. Study design Prospective, comparative, randomized. blinded trial. Animals Forty healthy bitches, aged 1-6 years, weighing 10-35 kg Methods The animals were randomly divided into four groups and received their respective treatments immediately after surgery: placebo group (0.9% saline solution), D15 group (metamizol 15 mg kg(-1) IV), D25 group (metamizol 25 mg kg(-1) IV), D35 group (metamizol 35 mg kg(-1) IV). The following variables were measured: sedation, pulse rate (PR). respiratory rate (f(R)). arterial blood pressure (ABP), plasma catecholamines. serum cortisol, blood urea nitrogen (BUN) and creatinine metabolites. albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP). hemogram. platelet counts and level of analgesia which was assessed by visual analog (VAS). descriptive and behavioral scales. Patients were monitored for 48 hours after the administration of the analgesic agent. Rescue analgesia (tramadol, 2 mg kg(-1), intramuscularly) was provided for animals with pain scores >= 4, as determined by the VAS or descriptive scale. Results The D25 and D35 groups showed equivalent post-operative analgesia, as shown by decreased pain scores, according to the three different pain scales, and fewer animals that required rescue analgesia. Significantly lower serum cortisol concentrations were observed in the D25 and D35 groups when compared to the placebo and D15 groups. No hematologic, renal, hepatic or clinical adverse effects were observed during the treatment. Conclusions and clinical relevance Metamizol administered intravenously at 25 or 35 mg kg(-1) can provide adequate post-operative analgesia in bitches undergoing ovariohysterectomy.
  • article 27 Citação(ões) na Scopus
    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 Adel
    Postoperative 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.