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

81. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA 27339124 2016 07 21 2017 03 16 2017 04 18 1528-1132 475 1 2017 Jan Clinical orthopaedics and related research Clin. Orthop. Relat. Res. No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA. 94-105 10.1007/s11999-016-4931-z Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (...) (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphine-based spinal anesthesia or ropivacaine-based PAI in controlling

EvidenceUpdates2016

82. An Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia After Medial Unicondylar Knee Arthroplasty

An Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia After Medial Unicondylar Knee Arthroplasty 26771270 2016 03 23 2016 07 28 2016 03 23 1526-7598 122 4 2016 Apr Anesthesia and analgesia Anesth. Analg. An Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia After Medial Unicondylar Knee Arthroplasty. 1192-201 10.1213/ANE.0000000000001162 Unicondylar knee arthroplasty (UKA) is a commonly performed procedure with significant (...) expected postoperative pain. Peripheral nerve blocks are 1 analgesic option, but some approaches may decrease quadriceps motor strength and interfere with early ambulation. In this study, we compared the analgesia provided by an adductor canal block (ACB) and a psoas compartment block (PCB) after UKA. We hypothesized that the ACB would provide equivalent analgesia, defined as a difference of <2 points on the pain scale (0-10 numeric rating scale [NRS]), at rest and with movement 6 hours after block

EvidenceUpdates2016

83. Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction

Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction 26938989 2016 04 20 2016 08 29 2016 04 20 1528-1175 124 5 2016 May Anesthesiology Anesthesiology Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction. 1053-64 10.1097/ALN.0000000000001045 By targeting the distal branches (...) of the femoral nerve in the mid-thigh, the adductor canal block (ACB) can preserve quadriceps muscle strength while providing analgesia similar to a conventional femoral nerve block (FNB) for inpatients undergoing major knee surgery. In this randomized, double-blind, noninferiority trial, the authors hypothesized that ACB provides postoperative analgesia that is at least as good as FNB while preserving quadriceps strength after outpatient anterior cruciate ligament reconstruction. A total of 100 patients

EvidenceUpdates2016

84. Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study.

Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. 26865083 2016 02 11 2017 03 03 1432-0932 26 3 2017 Mar European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Eur Spine J Does continuous wound infiltration enhance baseline intravenous (...) multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. 832-839 10.1007/s00586-016-4428-1 There has been a growing interest in continuous local anaesthetic wound infiltration as a non-opioid technique for postoperative pain relief. The impact of this modality on baseline analgesia after spinal fusion surgery has however been inconclusive. We tested whether continuous wound infiltration with ropivacaine can enhance postoperative analgesia

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2016

85. Analgesia - mild-to-moderate pain

Analgesia - mild-to-moderate pain Analgesia - mild-to-moderate pain - NICE CKS Clinical Knowledge Summaries Share Analgesia - mild-to-moderate pain - Summary For adults, a stepwise strategy for managing mild-to-moderate pain is recommended: Step 1 - paracetamol. This should be increased to the maximum dose of 1 gram four times a day, before switching to (or combining with) another analgesic. Step 2 - paracetamol should be substituted with low-dose ibuprofen (400 mg three times a day (...) be continued and ibuprofen replaced with an alternative NSAID such as naproxen (250 mg to 500 mg twice a day). Step 5 - a full therapeutic dose of a weak opioid (such as codeine 60 mg up to four times a day; maximum 240 mg daily) should be started in addition to full-dose paracetamol and/or an NSAID. General points to consider when prescribing analgesics. The underlying cause of the pain should be treated whenever possible. People who experience continuous pain should receive regular analgesia following

NICE Clinical Knowledge Summaries2016

86. PENTHROX, methoxyflurane, anaesthetic for emergency analgesia

PENTHROX, methoxyflurane, anaesthetic for emergency analgesia Haute Autorité de Santé - PENTHROX, méthoxyflurane, anesthésique pour antalgie d’urgence Contribuer à la régulation par la qualité et l'efficience Recherche Évaluation & Recommandation La HAS Accréditation & Certification Outils, Guides & Méthodes Agenda Avis sur les Médicaments PENTHROX, méthoxyflurane, anesthésique pour antalgie d’urgence Substance active (DCI) méthoxyflurane DOULEUR - Nouveau médicament Nature de la demande

Haute Autorite de sante2016

87. Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial)

Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial) 26447461 2015 12 24 2016 04 26 2015 12 24 1365-2168 102 13 2015 Dec The British journal of surgery Br J Surg Randomized clinical trial of perioperative nerve block and continuous local anaesthetic infiltration via wound catheter versus epidural analgesia in open liver resection (LIVER 2 trial). 1619-28 10.1002 (...) /bjs.9949 Analgesia after liver surgery remains controversial. A previous randomized trial of continuous wound infiltration (CWI) versus thoracic epidural analgesia (TEA) after liver surgery (LIVER trial) showed a faster recovery time in the wound infiltration group but better early postoperative pain scores in the TEA group. High-level evidence is, however, limited and opinion remains divided. The aim was to determine whether there is a difference in functional recovery time between patients

EvidenceUpdates2015

88. Intra-articular and portal infiltration versus wrist block for analgesia after arthroscopy of the wrist: a prospective RCT

Intra-articular and portal infiltration versus wrist block for analgesia after arthroscopy of the wrist: a prospective RCT 26330593 2015 09 02 2015 11 23 2016 05 25 2049-4408 97-B 9 2015 Sep The bone & joint journal Bone Joint J Intra-articular and portal infiltration versus wrist block for analgesia after arthroscopy of the wrist: a prospective RCT. 1250-6 10.1302/0301-620X.97B9.35096 Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role (...) in arthroscopy of the wrist remains unexplored. Chondrotoxicity has been a concern with the intra-articular infiltration of local anaesthetic. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration with a wrist block on the pain experienced by patients after arthroscopy of the wrist. A prospective, randomised, double-blind trial was designed and patients undergoing arthroscopy of the wrist under general anaesthesia as a day case were recruited for the study. Levo

EvidenceUpdates2015

89. An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded Study

An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded Study 26378397 2015 12 15 2016 04 06 2015 12 15 1528-1175 123 6 2015 Dec Anesthesiology Anesthesiology An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded (...) Study. 1256-66 10.1097/ALN.0000000000000852 Common standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission. A randomized, single-blinded study was conducted after obtaining

EvidenceUpdates2015

90. Effects of Intravenous Patient-Controlled Sufentanil Analgesia and Music Therapy on Pain and Hemodynamics After Surgery for Lung Cancer: A Randomized Parallel Study.

Effects of Intravenous Patient-Controlled Sufentanil Analgesia and Music Therapy on Pain and Hemodynamics After Surgery for Lung Cancer: A Randomized Parallel Study. 26331434 2015 11 05 2016 08 26 2015 11 05 1557-7708 21 11 2015 Nov Journal of alternative and complementary medicine (New York, N.Y.) J Altern Complement Med Effects of Intravenous Patient-Controlled Sufentanil Analgesia and Music Therapy on Pain and Hemodynamics After Surgery for Lung Cancer: A Randomized Parallel Study. 667-72 (...) 10.1089/acm.2014.0310 Postoperative pain is caused by surgical injury and trauma; is stressful to patients; and includes a series of physiologic, psychological, and behavioral reactions. Effective postoperative analgesia helps improve postoperative pain, perioperative safety, and hospital discharge rates. This study aimed to observe the influence of postoperative intravenous sufentanil patient-controlled analgesia combined with music therapy versus sufentanil alone on hemodynamics and analgesia in

Journal of alternative and complementary medicine (New York, N.Y.)2015

91. Multimodal Analgesia in Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on Additional Efficacy of Periarticular Anesthesia

Multimodal Analgesia in Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on Additional Efficacy of Periarticular Anesthesia 26072302 2015 11 09 2016 06 27 2015 11 09 1532-8406 30 11 2015 Nov The Journal of arthroplasty J Arthroplasty Multimodal Analgesia in Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on Additional Efficacy of Periarticular Anesthesia. 2038-42 10.1016/j.arth.2015.05.035 S0883-5403(15)00428-3 Pain management is a main determinant (...) of functional recovery after total knee arthroplasty (TKA). We performed a randomized, controlled, double blind study to evaluate additive efficacy of periarticular anesthesia in patients undergoing TKA in reducing post-operative pain, operated limb edema and improving post-operative mobility. Patients were randomly assigned to study or control group; all subjects received the same analgesic protocol; before wound closure, the study group received also a periarticular anesthesia (ropivacaine 1% 20 mL

EvidenceUpdates2015

92. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial.

Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. 26324284 2016 04 27 2017 05 07 1432-0932 25 5 2016 May European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Eur Spine J Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial (...) . 1614-1619 10.1007/s00586-015-4216-3 To assess the efficacy of a novel preemptive multimodal analgesic regimen for reducing postoperative pain and complications after primary lumbar fusion surgery. Preemptive multimodal analgesia is revealed to be an effective alternative to conventional morphine administration providing improved postoperative pain control with diminished side effects. However, an optimal regimen for spinal fusion surgery remains unknown. After Institutional Review Board approval

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2015

93. Epidural Analgesia During Childbirth: Safety and Guidelines

Epidural Analgesia During Childbirth: Safety and Guidelines Epidural Analgesia During Childbirth: Safety and Guidelines | CADTH.ca Find the information you need Epidural Analgesia During Childbirth: Safety and Guidelines Epidural Analgesia During Childbirth: Safety and Guidelines Published on: August 4, 2015 Project Number: RB0893-000 Product Line: Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical evidence regarding the safety of epidural (...) analgesia for mothers and babies during and after childbirth? What are the evidence-based guidelines regarding the use of epidural analgesia during childbirth? Key Message One health technology assessment, three systematic reviews (two with meta-analysis), and one evidence-based guideline were identified regarding the safety and recommended use of epidural analgesia during childbirth. Tags analgesia, anesthesia, labor pain, natural childbirth, gynecology/obstetrics, Delivery, Epidural, Labor, Obstetric

Canadian Agency for Drugs and Technologies in Health - Rapid Review2015

94. Epidural Analgesia During Childbirth: Safety and Guidelines

Epidural Analgesia During Childbirth: Safety and Guidelines Epidural Analgesia During Childbirth: Safety and Guidelines | CADTH.ca Find the information you need Epidural Analgesia During Childbirth: Safety and Guidelines Epidural Analgesia During Childbirth: Safety and Guidelines Published on: August 4, 2015 Project Number: RB0893-000 Product Line: Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical evidence regarding the safety of epidural (...) analgesia for mothers and babies during and after childbirth? What are the evidence-based guidelines regarding the use of epidural analgesia during childbirth? Key Message One health technology assessment, three systematic reviews (two with meta-analysis), and one evidence-based guideline were identified regarding the safety and recommended use of epidural analgesia during childbirth. Tags analgesia, anesthesia, labor pain, natural childbirth, gynecology/obstetrics, Delivery, Epidural, Labor, Obstetric

Canadian Agency for Drugs and Technologies in Health - Rapid Review2015

95. PAin SoluTions In the Emergency Setting (PASTIES)-patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial.

PAin SoluTions In the Emergency Setting (PASTIES)-patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial. OBJECTIVE: To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain. DESIGN: Pragmatic, multicentre, parallel group, randomised controlled trial SETTING (...) : Five English hospitals. PARTICIPANTS: 200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours. INTERVENTIONS: Patient controlled analgesia or nurse titrated analgesia (treatment as usual). MAIN OUTCOME MEASURES: The primary outcome was total pain experienced over the 12 hour study period

BMJ2015 Full Text: Link to full Text with Trip Pro

96. PAin SoluTions In the Emergency Setting (PASTIES)-patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial.

PAin SoluTions In the Emergency Setting (PASTIES)-patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial. OBJECTIVE: To determine whether patient controlled analgesia (PCA) is better than routine care in patients presenting to emergency departments with moderate to severe pain from traumatic injuries. DESIGN: Pragmatic, multicentre, parallel group, randomised controlled trial. SETTING: Five English hospitals (...) . PARTICIPANTS: 200 adults (71% (n = 142) male), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe pain from traumatic injuries and were expected to be admitted to hospital for at least 12 hours. INTERVENTIONS: PCA (n = 99) or nurse titrated analgesia (treatment as usual; n = 101). MAIN OUTCOME MEASURES: The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under

BMJ2015 Full Text: Link to full Text with Trip Pro

97. Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia

Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia 25740026 2015 03 05 2015 04 23 2016 05 12 1535-1386 97 5 2015 Mar 04 The Journal of bone and joint surgery. American volume J Bone Joint Surg Am Pain control after simultaneous bilateral total knee arthroplasty: a randomized controlled trial comparing periarticular injection and epidural analgesia. 367-73 10.2106/JBJS.N.00373 Periarticular (...) injection is becoming more commonly utilized for pain relief following total knee arthroplasty. However, we are aware of no randomized controlled trial that has investigated the efficacy of periarticular injection for pain relief after simultaneous bilateral total knee arthroplasty. We performed a randomized controlled trial of patients scheduled for simultaneous bilateral total knee arthroplasty. Seventy-one patients with 142 involved knees were randomly assigned to receive periarticular injection

EvidenceUpdates2015

98. Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients

Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients 25772701 2015 04 08 2015 12 29 2015 04 08 1496-8975 62 5 2015 May Canadian journal of anaesthesia = Journal canadien d'anesthesie Can J Anaesth Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients. 476-84 10.1007/s12630-014-0310-y Gabapentin was investigated as a single-dose adjunct to morphine for postoperative (...) pain management. The primary objective was to determine if gabapentin given preoperatively and for two days postoperatively as part of multimodal analgesia would decrease postoperative morphine consumption in patients undergoing primary total hip arthroplasty (THA). The study group included 102 patients aged 19-90 years who were undergoing primary THA in a single joint with no contraindications to the study medications, no chronic pain syndrome, and no chronic opioid use. Intervention group

EvidenceUpdates2015

99. Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study

Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study 25512031 2015 02 09 2015 08 04 2015 02 09 1532-8406 30 2 2015 Feb The Journal of arthroplasty J Arthroplasty Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study (...) . 320-4 10.1016/j.arth.2014.07.016 S0883-5403(14)00484-7 The aim of the study was to determine whether the addition the long-acting opioid buprenorphine as an adjuvant to the local anaesthetic agent would improve quality and prolong duration of femoral nerve blockade in post-operative analgesia following primary total knee arthroplasty. The study involved 48 patients. The femoral nerve was anaesthetised with a 0.25% solution of bupivacaine with adrenaline or with the addition of 0.3mg

EvidenceUpdates2015

100. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial.

Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial. 25713015 2015 02 25 2015 06 01 2015 10 28 1756-1833 350 2015 Feb 23 BMJ (Clinical research ed.) BMJ Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial. h846 10.1136/bmj.h846 To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared (...) with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an intention to deliver vaginally. To exclude a clinically relevant difference in satisfaction with pain relief of more than 10%, we needed to include 1136 women. Because of missing values for satisfaction this number was increased to 1400 before any analysis. We used multiple imputation to correct for missing data. Before

BMJ2015 Full Text: Link to full Text with Trip Pro