Indirect Bonding Method: in vitro Comparison of the Shear Bond Strength between Metallic Orthodontic Brackets and Different Porcelain Surface Preparations

Introduction : La force d’adhésion à l'interface métal-céramique avec les résines auto-polymérisantes destinées au collage indirect des boîtiers orthodontiques n'a pas été évaluée à ce jour et un protocole clinique basé sur la littérature scientifique est inexistant. Objectifs : 1) Comparer la force de cisaillement maximale entre des boîtiers métalliques et des surfaces en porcelaine préparées selon différentes méthodes; 2) Suggérer un protocole clinique efficace et prévisible. Matériel et méthodes : Quatre-vingt-dix disques en leucite (6 groupes; n = 15/groupe) ont été préparés selon 6 combinaisons de traitements de surface : mécaniques (+ / - fraisage pour créer les rugosités) et chimiques (acide fluorhydrique, apprêt, silane). Des bases en résine composite Transbond XT (3M Unitek, Monrovia, California) faites sur mesure ont été collées avec le système de résine adhésive auto-polymérisante Sondhi A + B Rapid Set (3M Unitek, Monrovia, California). Les échantillons ont été préservés (H2O/24hrs), thermocyclés (500 cycles) et testés en cisaillement (Instron, Norwood, Massachusetts). Des mesures d’Index d’adhésif résiduel (IAR) ont été compilées. Des tests ANOVAs ont été réalisés sur les rangs étant donné que les données suivaient une distribution anormale et ont été ajustés selon Tukey. Un Kruskall-Wallis, U-Mann Whitney par comparaison pairée et une analyse de Weibull ont aussi été réalisés. Résultats : Les médianes des groupes varient entre 17.0 MPa (- fraisage + acide fluorhydrique) à 26.7 MPa (- fraisage + acide fluorhydrique + silane). Le fraisage en surface ne semble pas affecter l’adhésion. La combinaison chimique (- fraisage + silane + apprêt) a démontré des forces de cisaillement significativement plus élevées que le traitement avec (- fraisage + acide fluorhydrique), p<0,05, tout en possédant des forces similaires au protocole typiquement suggéré à l’acide fluorhydrique suivi d’une application de silane, l’équivalence de (- fraisage + acide fluorhydrique + silane). Les mesures d’IAR sont significativement plus basses dans le groupe (- fraisage + acide fluorhydrique) en comparaison avec celles des 5 autres groupes, avec p<0,05. Malheureusement, ces 5 groupes ont des taux de fracture élévés de 80 à 100% suite à la décimentation des boîtiers. Conclusion : Toutes les combinaisons de traitement de surface testées offrent une force d’adhésion cliniquement suffisante pour accomplir les mouvements dentaires en orthodontie. Une application de silane suivie d’un apprêt est forte intéressante, car elle est simple à appliquer cliniquement tout en permettant une excellente adhésion. Il faut cependant avertir les patients qu’il y a un risque de fracture des restorations en céramique lorsque vient le moment d’enlever les broches. Si la priorité est de diminuer le risque d’endommager la porcelaine, un mordançage seul à l’acide hydrofluorique sera suffisant.

Impacts fonctionnels du traumatisme craniocérébral léger sur la vision et l'équilibre postural chez l'adulte

Le traumatisme craniocérébral léger (TCCL) a des effets complexes sur plusieurs fonctions cérébrales, dont l’évaluation et le suivi peuvent être difficiles. Les problèmes visuels et les troubles de l’équilibre font partie des plaintes fréquemment rencontrées après un TCCL. En outre, ces problèmes peuvent continuer à affecter les personnes ayant eu un TCCL longtemps après la phase aiguë du traumatisme. Cependant, les évaluations cliniques conventionnelles de la vision et de l’équilibre ne permettent pas, la plupart du temps, d’objectiver ces symptômes, surtout lorsqu’ils s’installent durablement. De plus, il n’existe pas, à notre connaissance, d’étude longitudinale ayant étudié les déficits visuels perceptifs, en tant que tels, ni les troubles de l’équilibre secondaires à un TCCL, chez l’adulte. L’objectif de ce projet était donc de déterminer la nature et la durée des effets d’un tel traumatisme sur la perception visuelle et sur la stabilité posturale, en évaluant des adultes TCCL et contrôles sur une période d’un an. Les mêmes sujets, exactement, ont participé aux deux expériences, qui ont été menées les mêmes jours pour chacun des sujets. L’impact du TCCL sur la perception visuelle de réseaux sinusoïdaux définis par des attributs de premier et de second ordre a d’abord été étudié. Quinze adultes diagnostiqués TCCL ont été évalués 15 jours, 3 mois et 12 mois après leur traumatisme. Quinze adultes contrôles appariés ont été évalués à des périodes identiques. Des temps de réaction (TR) de détection de clignotement et de discrimination de direction de mouvement ont été mesurés. Les niveaux de contraste des stimuli de premier et de second ordre ont été ajustés pour qu’ils aient une visibilité comparable, et les moyennes, médianes, écarts-types (ET) et écarts interquartiles (EIQ) des TR correspondant aux bonnes réponses ont été calculés. Le niveau de symptômes a également été évalué pour le comparer aux données de TR. De façon générale, les TR des TCCL étaient plus longs et plus variables (plus grands ET et EIQ) que ceux des contrôles. De plus, les TR des TCCL étaient plus courts pour les stimuli de premier ordre que pour ceux de second ordre, et plus variables pour les stimuli de premier ordre que pour ceux de second ordre, dans la condition de discrimination de mouvement. Ces observations se sont répétées au cours des trois sessions. Le niveau de symptômes des TCCL était supérieur à celui des participants contrôles, et malgré une amélioration, cet écart est resté significatif sur la période d’un an qui a suivi le traumatisme. La seconde expérience, elle, était destinée à évaluer l’impact du TCCL sur le contrôle postural. Pour cela, nous avons mesuré l’amplitude d’oscillation posturale dans l’axe antéropostérieur et l’instabilité posturale (au moyen de la vitesse quadratique moyenne (VQM) des oscillations posturales) en position debout, les pieds joints, sur une surface ferme, dans cinq conditions différentes : les yeux fermés, et dans un tunnel virtuel tridimensionnel soit statique, soit oscillant de façon sinusoïdale dans la direction antéropostérieure à trois vitesses différentes. Des mesures d’équilibre dérivées de tests cliniques, le Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) et le Balance Error Scoring System (BESS) ont également été utilisées. Les participants diagnostiqués TCCL présentaient une plus grande instabilité posturale (une plus grande VQM des oscillations posturales) que les participants contrôles 2 semaines et 3 mois après le traumatisme, toutes conditions confondues. Ces troubles de l’équilibre secondaires au TCCL n’étaient plus présents un an après le traumatisme. Ces résultats suggèrent également que les déficits affectant les processus d’intégration visuelle mis en évidence dans la première expérience ont pu contribuer aux troubles de l’équilibre secondaires au TCCL. L’amplitude d’oscillation posturale dans l’axe antéropostérieur de même que les mesures dérivées des tests cliniques d’évaluation de l’équilibre (BOT-2 et BESS) ne se sont pas révélées être des mesures sensibles pour quantifier le déficit postural chez les sujets TCCL. L’association des mesures de TR à la perception des propriétés spécifiques des stimuli s’est révélée être à la fois une méthode de mesure particulièrement sensible aux anomalies visuomotrices secondaires à un TCCL, et un outil précis d’investigation des mécanismes sous-jacents à ces anomalies qui surviennent lorsque le cerveau est exposé à un traumatisme léger. De la même façon, les mesures d’instabilité posturale se sont révélées suffisamment sensibles pour permettre de mesurer les troubles de l’équilibre secondaires à un TCCL. Ainsi, le développement de tests de dépistage basés sur ces résultats et destinés à l’évaluation du TCCL dès ses premières étapes apparaît particulièrement intéressant. Il semble également primordial d’examiner les relations entre de tels déficits et la réalisation d’activités de la vie quotidienne, telles que les activités scolaires, professionnelles ou sportives, pour déterminer les impacts fonctionnels que peuvent avoir ces troubles des fonctions visuomotrice et du contrôle de l’équilibre.

The Plurality Strategy on Graphs

The Majority Strategy for finding medians of a set of clients on a graph can be relaxed in the following way: if we are at v, then we move to a neighbor w if there are at least as many clients closer to w than to v (thus ignoring the clients at equal distance from v and w). The graphs on which this Plurality Strategy always finds the set of all medians are precisely those for which the set of medians induces always a connected subgraph

Fracturas del tercio medio de la clavícula en pacientes laboralmente activos tratamiento quirúrgico versus ortopédico

Introducción:. Para el tratamiento de pacientes con fractura del tercio medio de clavícula encontramos el ortopédico y quirúrgico, se desconoce a nivel local cuál alternativas ofrece un mejor desenlace. Materiales y Métodos: Estudio de cohorte retrospectiva, en pacientes con fractura del tercio medio de la clavícula comparando pacientes expuestos a tratamiento quirúrgico versus tratamiento ortopédico evaluando alteración estética, dolor, sesiones de fisioterapia, reintegro laboral y puntaje del DASH a los 3 meses de tratamiento. Resultados: 91 pacientes tratados ortopédicamente y 24 tratados quirúrgicamente. Mediana de edad 34.1 años para ambos tratamientos. El 20.2% de los pacientes sometidos al tratamiento quirúrgico presentaron dolor mientras que ningún paciente del grupo ortopédico presentó dolor después del tratamiento. El 79.1% de pacientes tratados ortopédicamente y el 20.9% tratados quirúrgicamente referían alteración estética. La medina de sesiones de fisioterapia realizadas para el tratamiento ortopédico fue 8.04 y 9.04 del quirúrgico. El promedio de reintegro laboral fue de 5 semanas para ambos tratamientos Discusión: Tanto el tratamiento ortopédico como el quirúrgico obtuvieron resultados muy similares para todas las variables medidas sin que se pueda concluir que uno sea mejor que el otro. Los pacientes con desplazamientos iniciales menores de 2 cm son candidatos para manejo ortopédico con buenos resultados con puntajes del DASH de 35 a los 3 meses tratamiento, los pacientes con desplazamientos iniciales mayores de 2 cm son los que con mayor frecuencia son sometidos a tratamientos quirúrgicos también encontrándose buenos resultados con puntajes del DASH de 38 a los 3 meses de tratamiento.

Performance and efficiency in Colombia's power utilities: an assessment of the 1994 reform

El artículo describe las características centrales de la reforma regulatoria al sector eléctrico en 1994 y evalúa el desempeño y la eficiencia de las empresas públicas antes y después de la reforma. El análisis de desempeño evalúa los cambios en medias y medianas en ganancias, eficiencia, inversión y ventas de las empresas privatizadas en el sector. La eficiencia técnica es estimada mediante la técnica DEA en una muestra de 33 plantas térmicas de energía, que representan el 85% del parque térmico; y 12 empresas distribuidoras de energía. La muestra de plantas generadoras está compuesta por plantas que estaban activas antes de la reforma y plantas nuevas que entraron en operación después de la reforma. Los principales resultados muestran que la eficiencia mejoro después de la reforma y que la política regulatoria ha tenido un efecto positivo en la eficiencia de la generación térmica de energía. Por el contrario, las distribuidoras de energía menos eficientes empeoraron después de la reforma y no llevaron a cabo una reestructuración para alcanzar la eficiencia productiva respecto a las empresas que conforman la frontera de eficiencia en distribución de energía.

Describing seasonal variability in the distribution of daily effective temperatures for 1985-2009 compared to 1904-1984 for De Bilt, Holland

This paper proposes a method for describing the distribution of observed temperatures on any day of the year such that the distribution and summary statistics of interest derived from the distribution vary smoothly through the year. The method removes the noise inherent in calculating summary statistics directly from the data thus easing comparisons of distributions and summary statistics between different periods. The method is demonstrated using daily effective temperatures (DET) derived from observations of temperature and wind speed at De Bilt, Holland. Distributions and summary statistics are obtained from 1985 to 2009 and compared to the period 1904–1984. A two-stage process first obtains parameters of a theoretical probability distribution, in this case the generalized extreme value (GEV) distribution, which describes the distribution of DET on any day of the year. Second, linear models describe seasonal variation in the parameters. Model predictions provide parameters of the GEV distribution, and therefore summary statistics, that vary smoothly through the year. There is evidence of an increasing mean temperature, a decrease in the variability in temperatures mainly in the winter and more positive skew, more warm days, in the summer. In the winter, the 2% point, the value below which 2% of observations are expected to fall, has risen by 1.2 °C, in the summer the 98% point has risen by 0.8 °C. Medians have risen by 1.1 and 0.9 °C in winter and summer, respectively. The method can be used to describe distributions of future climate projections and other climate variables. Further extensions to the methodology are suggested.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Climate change scenarios for precipitation extremes in Portugal

Precipitation indices are commonly used as climate change indicators. Considering four Climate Variability and Predictability-recommended indices, this study assesses possible changes in their spatial patterns over Portugal under future climatic conditions. Precipitation data from the regional climate model Consortium for Small-Scale Modelling–Climate version of the Local Model (CCLM) ensemble simulations with ECHAM5/MPI-OM1 boundary conditions are used for this purpose. For recent–past, medians and probability density functions of the CCLM-based indices are validated against station-based and gridded observational dataset from ENSEMBLES-based (gridded daily precipitation data provided by the European Climate Assessment & Dataset project) indices. It is demonstrated that the model is able to realistically reproduce not only precipitation but also the corresponding extreme indices. Climate change projections for 2071–2100 (A1B and B1 SRES scenarios) reveal significant decreases in total precipitation, particularly in autumn over northwestern and southern Portugal, though changes exhibit distinct local and seasonal patterns and are typically stronger for A1B than for B1. The increase in winter precipitation over northeastern Portugal in A1B is the most important exception to the overall drying trend. Contributions of extreme precipitation events to total precipitation are also expected to increase, mainly in winter and spring over northeastern Portugal. Strong projected increases in the dry spell lengths in autumn and spring are also noteworthy, giving evidence for an extension of the dry season from summer to spring and autumn. Although no coupling analysis is undertaken, these changes are qualitatively related to modifications in the large-scale circulation over the Euro-Atlantic area, more specifically to shifts in the position of the Azores High and associated changes in the large-scale pressure gradient over the area.

Dietary composition of pregnant women is related to size of the baby at birth

The fetal origins theory of adult disease suggests that term infants who are small for their gestational age have an increased susceptibility to chronic disease in adulthood as a consequence of physiologic adaptations to undernutrition during fetal life. Consistent evidence for an influence of women's dietary composition during pregnancy on growth of their babies is lacking, despite robust effects in animal experiments. We undertook a prospective observational study of 557 women aged 18-41 y, living in Adelaide, South Australia. Diet was assessed in early and late pregnancy using an FFQ. In early pregnancy, medians for energy intake, the proportion of energy derived from protein and from carbohydrate were 9.0 MJ, 17 and 48%, respectively. In late pregnancy the corresponding medians were 9.2 MJ, 16 and 49%. In early pregnancy, the percentage of energy derived from protein was positively associated with birth weight (P = 0.02) and placental weight (P = 0.07), independently of energy intake and weight gain during pregnancy, and after adjustment for potential confounders, including maternal age, parity, and smoking. Effects were stronger among women (n = 429) who had reliable data, based on prespecified criteria including the plausibility of dietary data when referenced against estimated energy expenditure. In addition, for this subgroup, the percentage of energy from carbohydrate in early and late pregnancy was negatively associated with ponderal index of the baby, and a specific effect of protein from dairy sources was identified. These data support the proposition that maternal dietary composition has an effect on fetal growth. Maternal diet in Western societies may therefore be important for the long-term health of the child.

A systematic approach to learning aimed at graduate physiotherapists practicing in South West Victoria

Mandatory standards developed by allied health professions for registration and accreditation purposes require continuing professional development (CPD) that can be accessed by all professionals, particularly those practicing in regions removed from the bigger cities. To improve and maintain competencies and standards of care CPD programs need to be accessible and provide opportunities for lifelong learning of efficacious evidence-based intervention. Despite the benefits of CPD, problems reported include access and lack of clarity on the usefulness of CPD in relation to clinical practice. The aim of this study was to develop a CPD program for physiotherapists in the south west of Victoria by employing a systematic approach that included a needs assessment as a vehicle to compose the 2004/2005 program and to optimise ease of attendance, relevance and perceived applicability to clinical practice. The education delivered was purposely in line with the principles of adult learning and presenters were instructed to focus for at least one-third of the workshop time on praxis. This study measured attendance levels throughout the program and satisfaction with the education received in terms of perceived clinical benefits in order to understand the benefits of employing detailed local needs assessments for rural professionals. All workshops and presentations were evaluated with regard to suitability of the venue, presenter style, content, applicability to clinical practice and overall impression by using 7-point Likert scales. Modes and medians both were 7, with seven being rated as highly successful. Attendance was high, 57.2% attended four or more sessions and 68.6% attended at least one workshop in the clinic over the period. In addition, 22.9% attended at least one of the two conducted courses that were held in that period. Although most physiotherapists (68.6%) reported some effect, 20% of the physiotherapists perceived that the CPD program had a large effect on their clinical skills and 29.4% found that patient demand had increased. This paper will discuss the results in light of approaches for allied health workplace learning.

The privatisation experience in banking and insurance in Australia

The role of ownership in performance of financial institutions is under-examined yet remains a topical issue. Whilst ownership changes in the banking sector have been evaluated in several studies, the link with other sectors has not been a focus of in depth analysis. A controlled comparison of performance between privatising banks and insurance firms in Australia is undertaken via a ‘meso’ approach of pairing privatising with comparator private institutions across the event period. Performance is evaluated using commercial CAMEL indicators and applying Wilcoxon rank tests (Otchere and Chan 2003) which provide statistically robust findings in the small annual data samples available around the privatisation event. Performance of privatising and private institutions is found to be quite similar before and after the event. For the privatising banks, some indicator medians improved to commercial levels (CBA) or were mostly unchanged (Colonial). By contrast one of the privatising insurance institutions (Suncorp) was found to outperform the private insurance comparator while there was little difference for the other (GIO).

Defining Bonferroni means over lattices

In the face of mass amounts of information and the need for transparent and fair decision processes, aggregation functions are essential for summarizing data and providing overall evaluations. Although families such as weighted means and medians have been well studied, there are still applications for which no existing aggregation functions can capture the decision makers' preferences. Furthermore, extensions of aggregation functions to lattices are often needed to model operations on L-fuzzy sets, interval-valued and intuitionistic fuzzy sets. In such cases, the aggregation properties need to be considered in light of the lattice structure, as otherwise counterintuitive or unreliable behavior may result. The Bonferroni mean has recently received attention in the fuzzy sets and decision making community as it is able to model useful notions such as mandatory requirements. Here, we consider its associated penalty function to extend the generalized Bonferroni mean to lattices. We show that different notions of dissimilarity on lattices can lead to alternative expressions.

Clustering of diet, physical activity and sedentary behaviour among Australian children: cross-sectional and longitudinal associations with overweight and obesity

BACKGROUND/OBJECTIVES: Evidence suggests diet, physical activity (PA) and sedentary behaviour cluster together in children, but research supporting an association with overweight/obesity is equivocal. Furthermore, the stability of clusters over time is unknown. The aim of this study was to examine the clustering of diet, PA and sedentary behaviour in Australian children and cross-sectional and longitudinal associations with overweight/obesity. Stability of obesity-related clusters over 3-years was also examined. SUBJECTS/METHODS: Data were drawn from the baseline (T1: 2002/03) and follow-up waves (T2: 2005/06) of the Health Eating and Play Study. Parents of Australian children aged 5-6 (n=87) and 10-12 years (n=123) completed questionnaires. Children wore accelerometers and height and weight were measured. Obesity-related clusters were determined using K-medians cluster analysis. Multivariate regression models assessed cross-sectional and longitudinal associations between cluster membership, and BMI z-score and weight status. Kappa statistics assessed cluster stability over time. RESULTS: Three clusters, labelled 'most Healthy', 'Energy-dense (ED) consumers who watch TV' and 'high sedentary behaviour/low moderate-to-vigorous physical activity' were identified at baseline and at follow-up. No cross-sectional associations were found between cluster membership, and BMI z-score or weight status at baseline. Longitudinally, children in the 'ED consumers who watch TV' cluster had a higher odds of being overweight/obese at follow-up (OR=2.8; 95% CI: 1.1, 6.9; P<0.05). Tracking of cluster membership was fair to moderate in younger (K=0.24; P=0.0001) and older children (K=0.46; P<0.0001). CONCLUSIONS: This study identified an unhealthy cluster of TV viewing with ED food/drink consumption which predicted overweight/obesity in a small longitudinal sample of Australian children. Cluster stability was fair to moderate over three years and is a novel finding. Prospective research in larger samples is needed to examine how obesity-related clusters track over time and influence the development of overweight and obesity.International Journal of Obesity accepted article preview online, 24 April 2015. doi:10.1038/ijo.2015.66.

Analgesia em pós-operatório de toratomias : estudo prospectivo e randomizado

Introdução: A dor é um importante fator de incremento da morbidade e mortalidade em pacientes submetidos a procedimentos cirúrgicos que incluem toracotomias. Diversos fatores contribuem para que esses pacientes apresentem um alto grau de dor no pós-operatório, entre os quais a secção da pele, músculos e pleura, retração dos músculos e ligamentos pelo afastador de Finochietto, irritação da pleura e nervos intercostais pelos drenos tubulares torácicos e fraturas ocasionais dos arcos costais. O aumento das taxas de morbidade e mortalidade é dado principalmente à respiração superficial decorrente da pouca mobilidade da parede torácica e conseqüente à dor e pela perda da efetividade do principal mecanismo de eliminação de secreções da árvore traqueobrônquica (tosse), resultando em atelectasias, inadequado gradiente ventilação / perfusão, hipoxemia e pneumonia. Uma vez caracterizada a necessidade de atenuação da dor como fator primordial na melhora dos índices de morbidade e mortalidade no período pós-operatório de cirurgia torácica, torna-se imperiosa uma análise das terapêuticas disponíveis na atualidade para tanto. Objetivos: Avaliar a utilização de três diferentes métodos de analgesia: 1. bloqueio peridural com morfina (BPM); 2. morfina parenteral (MP); e 3. bloqueio intercostal extrapleural contínuo com lidocaína” (BIC), em pacientes submetidos a procedimentos que incluíram toracotomias em sua execução, além de analisar o custo financeiro desses métodos. Materiais e métodos: Trata-se de um estudo prospectivo, randomizado, no qual foram analisados 79 pacientes, submetidos a toracotomias, subdivididos de forma aleatória em três grupos, de acordo com a modalidade terapêutica instituída: 25 pacientes no grupo BIC, 29 pacientes no grupo BPM e 25 pacientes no grupo MP. Cada paciente foi observado e analisado por profissionais de enfermagem previamente treinados. As variáveis analisadas foram a dor e a sedação. (quantificadas através de escores e analisadas através do método de Kruskal-Wallis com correção pelo teste de Dunn), além do custo financeiro de cada método e da necessidade de administração de opióides adicionais. Resultados: As variáveis dor e sedação foram obtidas através das seguintes medianas, respectivamente: grupos BIC (2,5 e 0); BPM (4 e 0) e MP (3,5 e 0). O custo financeiro foi de US$ 78,69 para o grupo BIC; US$ 28,61 para o grupo BPM e US$ 11,98 para o grupo MP. A necessidade adicional de opióide foi de 4,2 mg/dia para o grupo BIC; 5,7 mg/dia para o grupo BPM e 10,7 mg/dia para o grupo MP. Conclusões: A intensidade da dor foi significativamente menor no grupo BIC, quando comparado ao grupo MP. Não foram identificadas diferenças significativas de intensidade da dor quando comparados os grupos BIC versus BPM e BPM versus MP. A intensidade de sedação foi significativamente maior no grupo MP quando comparado aos grupos BIC e BPM. Não foram evidenciadas diferenças significativas quanto à sedação entre os grupos BIC e BPM. O custo financeiro do grupo MP foi sensivelmente menor quando comparado aos grupos BIC e BPM. A necessidade adicional de morfina foi significativamente maior no grupo MP, quando comparados aos grupos BIC e BPM.