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Pain analgesia

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https://www.readbyqxmd.com/read/28212146/multimodal-analgesia-for-acute-postoperative-and-trauma-related-pain
#1
Rosemary C Polomano, Mechele Fillman, Nicholas A Giordano, April Hazard Vallerand, Kelly L Wiltse Nicely, Carla R Jungquist
: Multimodal analgesia, which combines analgesic drugs from different classes and employs analgesic techniques that target different mechanisms of pain, is recommended in the treatment of acute postoperative and trauma-related pain because its synergistic effect maximizes pain relief at lower analgesic doses, thereby reducing the risk of adverse drug effects. Using a case-based approach, this article reviews various multimodal analgesic therapies used in the treatment of acute pain; discusses their benefits; and summarizes findings from related research, recommendations from evidence-based practice guidelines, and expert consensus reports...
March 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28212102/prediction-of-patient-controlled-analgesic-consumption-a-multimodel-regression-tree-approach
#2
Yuh-Jyh Hu, Tien-Hsiung Ku, Yu-Hung Yang, Jia-Ying Shen
Several factors contribute to individual variability in postoperative pain; therefore, individuals consume postoperative analgesics at different rates. Although many statistical studies have analyzed postoperative pain and analgesic consumption, most have identified only the correlation and have not subjected the statistical model to further tests in order to evaluate its predictive accuracy. In this study involving 3052 patients, a multistrategy computational approach was developed for analgesic consumption prediction...
February 13, 2017: IEEE Journal of Biomedical and Health Informatics
https://www.readbyqxmd.com/read/28211895/electroacupuncture-attenuates-cfa-induced-inflammatory-pain-by-suppressing-nav1-8-through-s100b-trpv1-opioid-and-adenosine-pathways-in-mice
#3
Hsien-Yin Liao, Ching-Liang Hsieh, Chun-Ping Huang, Yi-Wen Lin
Pain is associated with several conditions, such as inflammation, that result from altered peripheral nerve properties. Electroacupuncture (EA) is a common Chinese clinical medical technology used for pain management. Using an inflammatory pain mouse model, we investigated the effects of EA on the regulation of neurons, microglia, and related molecules. Complete Freund's adjuvant (CFA) injections produced a significant mechanical and thermal hyperalgesia that was reversed by EA or a transient receptor potential V1 (TRPV1) gene deletion...
February 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28211285/can-local-infiltration-analgesia-increase-satisfaction-in-postoperative-short-term-pain-control-in-total-knee-arthroplasty
#4
David Barastegui, I Robert, E Palau, S Haddad, M Reverte-Vinaixa, L Lorente, M Cots
BACKGROUND: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient's early functional outcomes. OBJECTIVES: Compare length of stay (LOS) short-term pain control, and patients' satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. PATIENTS AND METHODS: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28210635/combined-spinal-epidural-for-vaginal-delivery-in-a-parturient-with-takayasu-s-arteritis
#5
Sean Patrick Clifford, Paul Brian Mick, Brian Matthew Derhake
Takayasu's arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu's arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient...
October 2016: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28208979/evaluation-of-the-efficacy-of-bupivacaine-0-5-alone-or-with-clonidine-1%C3%AE-g-kg-versus-control-in-a-single-level-paravertebral-blockin-patients-undergoing-pcnl-procedure
#6
Trupti S Kamble, Charulata Mahesh Deshpande
INTRODUCTION: Percutaneous Nephrolithotomy (PCNL) is a widely used procedure to remove complex upper tract renal calculi by means of a nephroscope. Although less invasive, PCNL is associated with significant pain owing to soft tissue injury. Most of these patients have mild to moderately compromised renal function. An anaesthesia plan that reduces intraoperative requirement of anaesthetics, analgesics, muscle relaxants and postoperative requirement of systemic analgesics is essential...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28207529/comparison-of-the-pro-postoperative-analgesia-of-intraoperative-dexmedetomidine-with-and-without-loading-dose-following-general-anesthesia-a-prospective-randomized-controlled-clinical-trial
#7
Wei Fan, Haikou Yang, Yong Sun, Jun Zhang, Guangming Li, Ying Zheng, Yi Liu
Intraoperative dexemdetomidine (DEX) with or without loading dose is well-established to improve postoperative pain control in patient-controlled analgesia (PCA). This study was designed to compare the pro-analgesia effect between the 2 in patients received general anesthesia.Seventy patients shceduced abdominal surgery under general anesthesia were randomly assigned into 3 groups which were maintained using propofol/remifentanil/Ringer solution (PRR), propofol/remifentanil/dexmedetomidine with (PRDw) or without (PRDo) a loading dose of dexmedetomidine before induction...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28203561/comparative-prospective-case-control-study-of-open-versus-laparoscopic-pyeloplasty-in-children-with-ureteropelvic-junction-obstruction-long-term-results
#8
Lisandro A Piaggio, Juan P Corbetta, Santiago Weller, Ricardo Augusto Dingevan, Víctor Duran, Javier Ruiz, Juan C Lopez
INTRODUCTION: We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study. MATERIALS AND METHODS: From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28203541/anesthetic-considerations-in-robotic-mitral-valve-surgery
#9
Kent H Rehfeldt, J Valery Andre, Matthew J Ritter
The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case...
January 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28203022/-clinical-evaluation-of-in-plane-ultrasound-guided-thoracic-paravertebral-block-using-laterally-intercostal-approach
#10
T Xu, M Li, Y Tian, J T Song, C Ni, X Y Guo
OBJECTIVE: To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach. METHODS: In the study, 27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively. The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine. The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles...
February 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28203020/-effect-of-continuous-femoral-nerve-block-combined-with-periarticular-local-infiltration-analgesia-on-early-operative-functional-recovery-after-total-knee-arthroplasty-a-randomized-double-blind-controlled-study
#11
Y Deng, T L Jiang, X X Yang, M Li, J Wang, X Y Guo
OBJECTIVE: To investigate the effects of early rehabilitation training after total knee arthroplasty surgery by continuous femoral nerve block (CFNB) with or without periarticular local infiltration analgesia (PLIA). METHODS: In this randomized, double-blind, controlled study, 100 patients under-going primary unilateral total knee arthroplasty in patients with knee osteoarthritis were enrolled. All the patients received CFNB for postoperative analgesia before combined spinal epidural anesthesia...
February 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/28197774/popliteal-block-for-lower-limb-surgery-in-children-with-cerebral-palsy-effect-on-sevoflurane-consumption-and-postoperative-pain-a-randomized-double-blinded-controlled-trial
#12
Derya Ozkan, Emel Gonen, Taylan Akkaya, Mesut Bakir
PURPOSE: The aim of this study was to evaluate the effects of a preoperative popliteal block on sevoflurane consumption, postoperative pain, and analgesic consumption in children with cerebral palsy (CP) following lower limb surgery. METHODS: Fifty-four patients undergoing lower limb surgery were randomized to receive either a popliteal block + general anaesthesia (group P, n = 27) or general anaesthesia without a popliteal block (group C, n = 27). After anesthesia induction with 50% N2O, O2, and 8% sevoflurane, a popliteal block was given to group P patients with ultrasound guidance as a single dose of 0...
February 14, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28196525/drug-based-pain-management-for-people-with-dementia-after-hip-or-pelvic-fractures-a-systematic-review
#13
Kai Moschinski, Silke Kuske, Silke Andrich, Astrid Stephan, Irmela Gnass, Erika Sirsch, Andrea Icks
BACKGROUND: Studies indicate that people with dementia do not receive the same amount of analgesia after a hip or pelvic fracture compared to those without cognitive impairment. However, there is no systematic review that shows to what extent drug-based pain management is performed for people with dementia following a hip or pelvic fracture. The aim of this systematic review was to identify and analyse studies that investigate drug-based pain management for people with dementia with a hip or pelvic fracture in all settings...
February 14, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28195183/interleukin-1%C3%AE-pre-treated-bone-marrow-stromal-cells-alleviate-neuropathic-pain-through-ccl7-mediated-inhibition-of-microglial-activation-in-the-spinal-cord
#14
Jian Li, Guoying Deng, Haowei Wang, Mei Yang, Rui Yang, Xiangnan Li, Xiaoping Zhang, Hongbin Yuan
Although neuropathic pain is one of the most intractable diseases, recent studies indicate that systemic or local injection of bone marrow stromal cells (BMSCs) decreases pro-inflammatory cytokines release and alleviates neuropathic pain. However, it is still not clear whether pre-treated BMSCs have a strong anti-inflammatory and/or analgesia effect. Using the spinal nerve ligation model of neuropathic pain, IL-1β pre-treated BMSCs (IL-1β-BMSCs) were injected into rats followed by SNL in order to determine possible effects...
February 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28194478/-diagnostic-investigation-in-emergency-medicine-why-case-history-is-crucial
#15
M Mirus, A R Heller
We present the preclinical case of a patient reporting chest pain. Pain impeded physical examination. Reviewing the patient's detailed medical history after analgesia revealed a connection between the reported pain and vomiting. This led to a suspicion of organ perforation. Thus, the patient was admitted to a surgical emergency room (ER) and Boerhaave's Syndrome was diagnosed. After deterioration in the ER, cardiopulmonal reanimation (CPR), and successful surgical treatment, the patient was transferred to the intensive care unit (ICU) seven hours after first contact...
February 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28194277/risk-factors-and-prognosis-of-pain-events-during-mechanical-ventilation-a-retrospective-study
#16
Ayahiro Yamashita, Masaki Yamasaki, Hiroki Matsuyama, Fumimasa Amaya
BACKGROUND: Pain assessment is highly recommended in patients receiving mechanical ventilation. However, pain intensity and its impact on outcomes in these patients remain obscure. We collected the results of routine pain assessments, utilizing the behavioral pain scale (BPS), from 151 patients receiving mechanical ventilation. Risk factors associated with a pain event, defined as BPS of >5, and its impact on patient outcomes were investigated. METHODS: A total of 151 consecutive adult patients receiving mechanical ventilation for more than 24 h in a single 10-bed ICU were enrolled in this study...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28194274/moderate-to-deep-sedation-technique-using-propofol-and-ketamine-allowing-synchronised-breathing-for-magnetic-resonance-high-intensity-focused-ultrasound-mr-hifu-treatment-for-uterine-fibroids-a-pilot-study
#17
Hermanus H B Vaessen, F M Knuttel, J M M van Breugel, M E Ikink, J M Dieleman, M A A J van den Bosch, J T A Knape
BACKGROUND: Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. The aim of this study was to explore if a sedation regimen with low-dose propofol and ketamine performed by trained non-medical sedation practitioners could result in relief of discomfort for the patient and in adequate working conditions for MR-HIFU treatment for uterine fibroids...
2017: Journal of Therapeutic Ultrasound
https://www.readbyqxmd.com/read/28192247/comparison-of-peri-articular-liposomal-bupivacaine-and-standard-bupivacaine-for-postsurgical-analgesia-in-total-knee-arthroplasty-a-systematic-review-and-meta-analysis
#18
REVIEW
Xi Wang, Lin Xiao, Zhiyuan Wang, Guanghui Zhao, Jianbing Ma
OBJECTIVE: This meta-analysis aimed to compare the efficacy and safety of intraoperative peri-articular liposomal bupivacaine and standard bupivacaine in patients undergoing total knee arthroplasty. METHODS: A systematic search was performed in Medline (1966-2016.9), PubMed (1966-2016.9), Embase (1980-2016.9), ScienceDirect (1985-2016.9) and the Cochrane Library. Only high-quality studies were selected. Meta-analysis was performed using Stata 11.0 software. RESULTS: Three randomized controlled trials (RCTs) and two non-randomized controlled trials (Non-RCTs), including 1214 patients met the inclusion criteria...
February 10, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28190665/intranasal-fentanyl-and-inhaled-nitrous-oxide-for-fracture-reduction-the-fan-observational-study
#19
J Hoeffe, E Doyon Trottier, B Bailey, D Shellshear, M Lagacé, C Sutter, G Grimard, R Cook, F E Babl
INTRODUCTION: Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions. METHODS: We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation...
January 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#20
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
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