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Latest & greatest articles for analgesia
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Analgesic drugs are used to provide analgesia, the inability to feel pain. There are numerous groups of analgesics including simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Analgesics types are prescribed differently depending on the severity of pain relief needed.
The most common type of analgesic generally known and used is non-steroidal anti-inflammatory drugs such as paracetamol, aspirin and ibuprofen. Opioid drugs include morphine, codeine, oxycodone, dihydromorphine and pethidine.
Research shows that analgesic drugs have an effect on the peripheral and central nervous system, relieving pain without the loss of consciousness. Opioids are highly effect pain relievers however case studies prove they can be highly addictive. Therefore use should be guided by the World Health Organization (WHO) pain ladder which specifies mild analgesics as its first step.
Clinical trials and studies carried out across all groups of analgesia have proven the drugs are highly effective painkillers, opioids in particular. However, years of research and clinical trials conclude that some groups have significant side effects such as addiction or cardiovascular side effects. Research evidence is broad including clinical guidelines, systematic reviews, randomised controlled trials, case studies etc. These can easily be found via a search of the Trip Database.
Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia. Opioids are a mainstay of acute pain management but can have many adverse effects, contributing to problematic long-term use. Opioid tolerance (increased dose needed for analgesia) and opioid-induced hyperalgesia (paradoxical increase in pain with opioid administration) can contribute to both poorly controlled pain and dose escalation. Hyperalgesia is particularly problematic
Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. General anaesthesia combined with epidural analgesia may have a beneficial effect on clinical outcomes. However, use of epidural analgesia for cardiac surgery is controversial due to a theoretical increased risk of epidural haematoma associated with systemic heparinization. This review was published in 2013, and it was updated in 2019.To determine the impact of perioperative epidural analgesia (...) in adults undergoing cardiac surgery, with or without cardiopulmonary bypass, on perioperative mortality and cardiac, pulmonary, or neurological morbidity.We searched CENTRAL, MEDLINE, and Embase in November 2018, and two trial registers up to February 2019, together with references and relevant conference abstracts.We included all randomized controlled trials (RCTs) including adults undergoing any type of cardiac surgery under general anaesthesia and comparing epidural analgesia versus another modality
Intravenous vs Oral Acetaminophen for Analgesia After Cesarean Delivery: A Randomized Trial Examination of postoperative analgesia with intravenous and oral acetaminophen.Prospective, three-arm, nonblinded, randomized clinical trial.A single academic medical center.Parturients scheduled for elective cesarean delivery.This trial randomized 141 parturients to receive intravenous acetaminophen (1 g every eight hours, three doses), oral acetaminophen (1 g every eight hours, three doses
Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial In the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.This double-blind, randomized controlled study (...) was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.Median 24 hours' opioid dose was greater in the control group
Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children. Spine surgery may be associated with severe acute postoperative pain. Compared with systemic analgesia alone, epidural analgesia may offer better pain control. However, epidural analgesia has sometimes been associated with rare but serious complications. Therefore, it is critical to quantify the real benefits of epidural analgesia over other modes of pain treatment.To assess (...) the effectiveness and safety of epidural analgesia compared with systemic analgesia for acute postoperative pain control after thoraco-lumbar spine surgery in children.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature on 14 November 2018, together with the references lists of related reviews and retained trials, and two trials registers.We included all randomized controlled trials performed in children
Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac (...) surgery.A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia. Risks of bias of included trials were judged with the Cochrane tool. Data were analyzed with fixed- (I < 25%) or random-effects models (I ≥ 25%). The quality of evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation working group scale.We included 14 randomized
Side Effect Rates of Opioids in Equianalgesic Doses Via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis Side effects of opioids used for the treatment of acute pain frequently limit their analgesic quality. Many studies have compared opioid side effects in patient-controlled analgesia (PCA), but it remains unclear whether there are specific side effect profiles that can be exploited when choosing an opioid for a patient. In this review, we wanted
Peripartum Analgesia and Anesthesia for the Breastfeeding Mother T BREASTFEEDING MEDICINE Volume 13, Number 3, 2018 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2018.29087.ejm ABM Clinical Protocol #28, Peripartum Analgesia and Anesthesia for the Breastfeeding Mother Erin Martin, 1 Barbara Vickers, 2 Ruth Landau, 3 Sarah Reece-Stremtan, 4 and the Academy of Breastfeeding Medicine A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial (...) and postpartum may improve outcomes by relieving suffering during labor; however, some of these methods may affect the course of labor and the neurobehavioral state of the neonate. Few studies directly address the impact of various ap- proaches to peripartum anesthesia and analgesia on breast- feeding outcomes. While a Cochrane review evaluated 38 studies published before 2011 on epidural analgesia com- pared with other pain management options, it is notable that only one assessed breastfeeding outcomes. 7
Local infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: a prospective, randomized, comparative noninferiority study involving 99 patients The aim of this study was to compare the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA). The hypothesis was that LIA is not inferior to ISB.A prospective, randomized controlled study
Epidural analgesia at trial of labor can increase the successful rate of vaginal birth after caesarean section(VBAC): a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content
The role of expectations in placebo analgesia: a meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr
Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when (...) combined with continuous adductor canal block and LIA.Ninety patients were recruited into the study and received spinal anesthesia, LIA, and continuous adductor canal block. They were further randomized to receive either an ONB (group 1), a TNB (group 2), or both (group 3). The primary outcome was total morphine consumption over the postoperative 24 hours. The secondary outcomes included visual analog scale scores, time to first and total dosage of rescue analgesia, Timed Up and Go test, range
A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery Surgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain caused by central sensitization. The role of pre-emptive analgesia (PA) and intraoperative analgesia in management of postoperative pain has gained precedence (...) over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory, and neuronal stimuli. Blockage of all three stimuli in the perioperative period by pre-emptively administrating a combination of paracetamol (P), ketorolac (K), and pregabalin (PR) might help in adequate management and alleviation of acute postoperative pain.To evaluate the analgesic effect of a combination of P, K, and PR as pre-emptive multimodal analgesia
CRACKCast E195 – Procedural Sedation and Analgesia CRACKCast E195 - Procedural Sedation and Analgesia - CanadiEM CRACKCast E195 – Procedural Sedation and Analgesia In , by Owen Scheirer November 5, 2018 This updated episode of CRACKCast cover’s Rosen’s Chapter 004, Procedural Sedation and Analgesia (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes – Key Concepts Safe, effective procedural sedation requires high-level skills and information (...) oximetry is mandatory during sedation, and end-tidal CO2 should be monitored if moderate or deep sedation is the goal. Oxygen should be administered to patients undergoing procedural sedation. Rosen’s in Perspective Providing procedural sedation and analgesia is something we do frequently in the emergency department. Our patients often need to undergo certain procedures that are anxiety provoking, painful, or generally unpleasant. Luckily, we have a vast array of medications at our disposal that can
Preemptive Analgesia with Parecoxib in Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial Total hip arthroplasty (THA) is a well-accepted surgical treatment for terminal hip diseases.To evaluate the effect of preemptive analgesia with parecoxib in patients undergoing primary unilateral THA.A randomized, double-blind, placebo-controlled study.This study was conducted at Peking Union Medical College Hospital and Beijing Jishuitan Hospital in Beijing, China.A total of 94 (...) patients scheduled for primary unilateral THA in 2 centers (Peking Union Medical College Hospital and Beijing Jishuitan Hospital) were randomly assigned to receive 40 mg parecoxib (n = 48) or 0.9% normal saline solution (n = 46) 30 minutes before incision. All patients received standardized intravenous patient-controlled analgesia (PCA) postoperatively. Preoperative baseline data, surgery-related conditions, postoperative Visual Analog Scale (VAS) pain score, cumulative narcotic consumption of PCA
Comparison of the Efficacy of Different Analgesia Treatments for Total Knee Arthroplasty: A Network Meta-Analysis The severe pain after total knee arthroplasty (TKA) brings many patients more suffering, longer hospital stay, and higher expenses. This study was designed to assess the relative efficacy of several clinical treatments for postoperative analgesia of TKA through network meta-analysis based on multiple published randomized controlled trials.Embase and PubMed were utilized to conduct (...) this network meta-analysis from inception until 2016. Pain score, morphine consumption (milligrams), and length of hospitalization (day) were selected as the endpoints.A total of 58 studies with 3501 patients were included in this network meta-analysis. Except for patient-controlled epidural analgesia+femoral nerve block (FNB) and sciatic nerve block, all treatments were significantly superior to placebo in pain score 6 to 8 hours. In terms of pain score 24 hours, only continuous femoral nerve block (cFNB
Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.Patients (N=50 (...) , 3-12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours