Latest & greatest articles for analgesia

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Analgesia

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.

Top results for analgesia

21. A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy

A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy 29614274 2018 05 25 1097-6868 218 6 2018 Jun American journal of obstetrics and gynecology Am. J. Obstet. Gynecol. A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. 599.e1-599.e8 S0002-9378(18)30248-5 10.1016 (...) intraoperative local analgesia that is administered at the level of the sacrospinous ligament can lessen the gluteal pain felt by patients postoperatively after sacrospinous ligament colpopexy. In a randomized double-blind placebo-controlled trial, women with vaginal apex prolapse who were undergoing surgical treatment with sacrospinous ligament colpopexy underwent intraoperative injection with either 0.25% bupivacaine or normal saline solution. Subjects completed visual analog pain scales (0-10

EvidenceUpdates2018

22. Preperitoneal or Subcutaneous Wound Catheters as Alternative for Epidural Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis

Preperitoneal or Subcutaneous Wound Catheters as Alternative for Epidural Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis 29781846 2018 05 21 1528-1140 2018 May 17 Annals of surgery Ann. Surg. Preperitoneal or Subcutaneous Wound Catheters as Alternative for Epidural Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis. 10.1097/SLA.0000000000002817 To assess whether the location of wound catheters (ie, preperitoneal vs. subcutaneous) impacts outcomes, when (...) compared with alternatives such as epidural analgesia. Continuous wound infiltration is an alternative for epidural analgesia in abdominal surgery but studies have shown conflicting results. This difference could be explained by different efficacy of preperitoneal versus subcutaneous placement of the infiltrative catheters. A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines until April 3, 2017. Primary

EvidenceUpdates2018

23. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. BACKGROUND: Regional anaesthesia may reduce the rate of persistent postoperative pain (PPP), a frequent and debilitating condition. This review was originally published in 2012 and updated in 2017. OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of PPP beyond three months in adults (...) the PROSPERO systematic review registry for related systematic reviews. SELECTION CRITERIA: We included RCTs comparing local or regional anaesthesia versus conventional analgesia with a pain outcome beyond three months after elective, non-orthopaedic surgery. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trial quality and extracted data and adverse events. We contacted study authors for additional information. We presented outcomes as pooled odds ratios (OR) with 95

Cochrane2018

24. Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial 29672368 2018 04 19 1532-8651 2018 Apr 18 Regional anesthesia and pain medicine Reg Anesth Pain Med Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial. 10.1097/AAP.0000000000000779 General anesthesia for breast surgery may be supplemented by using a regional (...) anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery. A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine

EvidenceUpdates2018

25. Intravenous Lidocaine Provides Similar Analgesia to Intravenous Morphine for Undifferentiated Severe Pain in the Emergency Department: A Pilot, Unblinded Randomized Controlled Trial

Intravenous Lidocaine Provides Similar Analgesia to Intravenous Morphine for Undifferentiated Severe Pain in the Emergency Department: A Pilot, Unblinded Randomized Controlled Trial 29741660 2018 05 09 1526-4637 2018 May 07 Pain medicine (Malden, Mass.) Pain Med Intravenous Lidocaine Provides Similar Analgesia to Intravenous Morphine for Undifferentiated Severe Pain in the Emergency Department: A Pilot, Unblinded Randomized Controlled Trial. 10.1093/pm/pny031 We compared the analgesic effects (...) to 2.9). Among participants in the lidocaine and morphine arms, 13% and 38%, respectively, had side effects. Patient satisfaction was similar in both arms (87% and 88%). Lidocaine arm patients averaged 4.5 mg of IV morphine (95% CI = 3.0 to 6.0) compared with 8.4 mg (95% CI = 6.9 to 9.8) in the morphine arm, an absolute difference of 3.9 mg (95% CI = 1.8 to 5.9). We found similar pain relief and satisfaction in both study arms. Lidocaine arm participants had fewer side effects and required less

EvidenceUpdates2018

26. Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study

Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study 29731664 2018 05 09 1178-7090 11 2018 Journal of pain research J Pain Res Perioperative analgesia with a buprenorphine transdermal patch for hallux valgus surgery: a prospective, randomized, controlled study. 867-873 10.2147/JPR.S153456 Hallux valgus surgery often results in significant postoperative pain. Adequate control of pain is essential for patient (...) satisfaction and improves the outcome of the procedure. This study aimed to investigate the perioperative analgesic effect of a buprenorphine transdermal patch in patients who underwent hallux valgus surgery. A total of 90 patients were randomly divided into the following three groups based on the perioperative analgesic method: flurbiprofen axetil intravenous injection (Group F), oral celecoxib (Group C), and buprenorphine transdermal delivery system (BTDS) (Group BTDS). The pain status, degree

EvidenceUpdates2018 Full Text: Link to full Text with Trip Pro

27. Epidural versus non-epidural or no analgesia for pain management in labour.

Epidural versus non-epidural or no analgesia for pain management in labour. BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011 (...) . OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (ClinicalTrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (30 April 2017), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials comparing all

Cochrane2018

28. Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour. BACKGROUND: Childbirth may cause the most severe pain some women experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour and is considered to be the reference standard. Traditionally epidural analgesia has been delivered as a continuous infusion via a catheter in the epidural space, with or without the ability for the patient to supplement the analgesia (...) received by activating a programmable pump to deliver additional top-up doses, known as patient-controlled epidural analgesia (PCEA). There has been interest in delivering maintenance analgesic medication via bolus dosing (automated mandatory bolus - AMB) instead of the traditional continuous basal infusion (BI); recent randomized controlled trials (RCTs) have shown that the AMB technique leads to improved analgesia and maternal satisfaction. OBJECTIVES: To assess the effects of automated mandatory

Cochrane2018

29. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. BACKGROUND: Regional anaesthesia may reduce the rate of persistent postoperative pain (PPP), a frequent and debilitating condition. This review was originally published in 2012 and updated in 2017. OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of PPP beyond three months in adults (...) the PROSPERO systematic review registry for related systematic reviews. SELECTION CRITERIA: We included RCTs comparing local or regional anaesthesia versus conventional analgesia with a pain outcome beyond three months after elective, non-orthopaedic surgery. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trial quality and extracted data and adverse events. We contacted study authors for additional information. We presented outcomes as pooled odds ratios (OR) with 95

Cochrane2018

30. Practice Guidelines for Moderate Procedural Sedation and Analgesia

Practice Guidelines for Moderate Procedural Sedation and Analgesia Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018:A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology* | Anesthesiology | ASA Publications (...) 2568626736 ASA Publications Log in to access full content You must be logged in to access this feature. ASA members enjoy complimentary access to ASA publications, as well as a variety of educational resources. Non-ASA Members Login Free Practice Parameter | March 2018 Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial

American Society of Anesthesiologists2018

31. Comparison of Periarticular Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: a Meta-Analysis of Randomized Controlled Trials

Comparison of Periarticular Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: a Meta-Analysis of Randomized Controlled Trials 29455938 2018 02 19 1532-8406 2018 Jan 11 The Journal of arthroplasty J Arthroplasty Comparison of Periarticular Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: a Meta-Analysis of Randomized Controlled Trials. S0883-5403(18)30004-4 10.1016/j.arth.2017.12.042 Total knee arthroplasty (TKA) is accompanied (...) by moderate-to-severe postoperative pain. Postoperative pain will hamper functional recovery and lower patients' satisfaction with surgery. Recently, periarticular local infiltration analgesia (LIA) has been widely used in TKA. However, there is no definite answer as to the efficacy and safety of LIA compared with femoral nerve block (FNB). Randomized controlled trials about relevant studies were searched from PubMed (1996 to July 2017), Embase (1980 to July 2017), and Cochrane Library (CENTRAL, July 2017

EvidenceUpdates2018

32. Efficacy of Ultrasound-Guided Serratus Plane Block on Postoperative Quality of Recovery and Analgesia After Video-Assisted Thoracic Surgery: A Randomized, Triple-Blind, Placebo-Controlled Study

Efficacy of Ultrasound-Guided Serratus Plane Block on Postoperative Quality of Recovery and Analgesia After Video-Assisted Thoracic Surgery: A Randomized, Triple-Blind, Placebo-Controlled Study 29324496 2018 03 16 1526-7598 126 4 2018 Apr Anesthesia and analgesia Anesth. Analg. Efficacy of Ultrasound-Guided Serratus Plane Block on Postoperative Quality of Recovery and Analgesia After Video-Assisted Thoracic Surgery: A Randomized, Triple-Blind, Placebo-Controlled Study. 1353-1361 10.1213/ANE (...) .0000000000002779 The optimal regional technique for analgesia and improved quality of recovery after video-assisted thoracic surgery (a procedure associated with considerable postoperative pain) has not been established. The main objective in this study was to compare quality of recovery in patients undergoing serratus plane block (SPB) with either ropivacaine or normal saline on the first postoperative day. Secondary outcomes were analgesic outcomes, including postoperative pain intensity and opioid

EvidenceUpdates2018

33. Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial

Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial 29351097 2018 03 13 1528-1175 128 4 2018 Apr Anesthesiology Anesthesiology Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial. 745-753 10.1097/ALN.0000000000002089 Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural (...) boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial

EvidenceUpdates2018

34. Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone

Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone 29346228 2018 02 07 1532-8651 2018 Jan 17 Regional anesthesia and pain medicine Reg Anesth Pain Med Analgesia of Combined Femoral Triangle and Obturator Nerve Blockade Is Superior to Local Infiltration Analgesia After Total Knee Arthroplasty With High-Dose Intravenous Dexamethasone. 10.1097/AAP.0000000000000731 (...) High-dose intravenous dexamethasone reduces the postoperative opioid requirement and is often included in the multimodal analgesia strategy after total knee arthroplasty (TKA). Combined obturator nerve and femoral triangle blockade (OFB) reduces the opioid consumption and pain after TKA better than local infiltration analgesia (LIA). The question is whether preoperative high-dose intravenous dexamethasone would cancel out the superior analgesic effect of OFB compared with LIA. The aim

EvidenceUpdates2018

35. Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial

Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial 29315129 2018 02 07 1532-8651 43 2 2018 Feb Regional anesthesia and pain medicine Reg Anesth Pain Med Relative Contributions of Adductor Canal Block and Intrathecal Morphine to Analgesia and Functional Recovery After Total Knee Arthroplasty: A Randomized Controlled Trial. 154-160 10.1097/AAP.0000000000000724 Effective (...) postoperative analgesia may enhance early rehabilitation after orthopedic surgery. This randomized double-blind trial investigates the relative contributions of adductor canal block and low-dose intrathecal morphine (ITM) to postoperative analgesia and functional recovery after total knee arthroplasty. Two-hundred one patients undergoing elective unilateral total knee arthroplasty under spinal anesthesia were randomized to 3 groups. All patients received standardized intraoperative local infiltration

EvidenceUpdates2018

36. Morphine versus fentanyl for spinal post-caesarean analgesia: a randomised controlled trial.

Morphine versus fentanyl for spinal post-caesarean analgesia: a randomised controlled trial. BACKGROUND: Finding appropriate analgesics is important for a mother's recovery after a caesarean section. The aim of this study was to compare the analgesic effect of spinal morphine and fentanyl for women undergoing a caesarean section. METHODS: In this randomised, unmasked, parallel-group, controlled trial, eligible participants were women undergoing caesarean section with spinal anaesthetic (...) , 18 h, and 24 h after the caesarean section. Time and amount of other analgesics needed were recorded (primary outcome). Secondary outcomes were nausea-vomiting scores (NVS 0-3, where 0 means no nausea or vomiting and 3 means severe nausea or vomiting that is unresponsive to antiemetics), and pruritus scores (PS 0-2, where 0 means no pruritus and 2 means severe pruritus). Data were analysed with SPSS. We compared outcomes using Mann-Whitney U-test, student's t-test, OR, or χ 2 test. The study

Lancet2018

37. A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique

A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique 29198872 2017 12 04 1532-8406 2017 Nov 16 The Journal of arthroplasty J Arthroplasty A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique. S0883-5403(17)31023-9 10.1016/j.arth.2017.11.018 Adductor canal blocks (ACBs) provide effective analgesia following (...) AN Department of Anesthesia and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada. Tang Raymond R Department of Anesthesia and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada. eng Journal Article 2017 11 16 United States J Arthroplasty 8703515 0883-5403 TKA analgesia adductor canal block dexamethasone peri-neural catheters regional anesthesia 2017 09 08 2017 10 25 2017 11 08 2017 12 5 6 0 2017 12 5 6 0 2017 12 5 6 0 aheadofprint 29198872

EvidenceUpdates2018

38. Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial

Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial 29233569 2017 12 13 1532-8406 2017 Nov 13 The Journal of arthroplasty J Arthroplasty Continuous Adductor Canal Blocks Provide Superior Ambulation and Pain Control Compared to Epidural Analgesia for Primary Knee Arthroplasty: A Randomized, Controlled Trial. S0883-5403(17)30986-5 10.1016/j.arth.2017.11.013 Adductor canal blocks (...) (ACBs) are an alternative to femoral nerve blocks that minimize lower extremity weakness. However, it is unclear whether this block will provide analgesia that is equivalent to techniques, such as epidural analgesia. The purpose of this randomized controlled trial was to compare continuous ACBs with epidural analgesia for primary total knee arthroplasty. Following institutional review board approval, 145 patients were randomized to 1 of 3 groups: combined spinal-epidural (CSE), spinal + continuous

EvidenceUpdates2018

39. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial

Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial 29150457 2017 12 11 2017 12 11 1098-4275 140 6 2017 Dec Pediatrics Pediatrics Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial. e20171935 10.1542/peds.2017-1935 There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities. This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during (...) circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure

EvidenceUpdates2018

40. Initiation of labor analgesia with injection of local anesthetic through the epidural needle compared to the catheter

Initiation of labor analgesia with injection of local anesthetic through the epidural needle compared to the catheter 29263693 2017 12 24 1178-7090 10 2017 Journal of pain research J Pain Res Initiation of labor analgesia with injection of local anesthetic through the epidural needle compared to the catheter. 2789-2796 10.2147/JPR.S145138 The rationale for injection of epidural medications through the needle is to promote sooner onset of pain relief relative to dosing through the epidural (...) catheter given that needle injection can be performed immediately after successful location of the epidural space. Some evidence indicates that dosing medications through the epidural needle results in faster onset and improved quality of epidural anesthesia compared to dosing through the catheter, though these dosing techniques have not been compared in laboring women. This investigation was performed to determine whether dosing medication through the epidural needle improves the quality of analgesia

EvidenceUpdates2018 Full Text: Link to full Text with Trip Pro