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Acute pain management

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https://www.readbyqxmd.com/read/28339431/perioperative-ketamine-administration-for-thoracotomy-pain
#1
Daniel W Moyse, Alan D Kaye, James H Diaz, Muhammad Y Qadri, David Lindsay, Srinivas Pyati
BACKGROUND: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28338596/operation-versus-antibiotics-the-appendicitis-conundrum-continues-a-meta-analysis
#2
Joseph V Sakran, Konstantinos S Mylonas, Alexandros Gryparis, Stanislaw P Stawicki, Christopher J Burns, Maher M Matar, Konstantinos P Economopoulos
BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. METHODS: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28337672/fentanyl-formulations-in-the-management-of-pain-an-update
#3
REVIEW
Stephan A Schug, Sonya Ting
Fentanyl is a synthetic, highly selective opioid with many desirable physicochemical properties, including a high lipophilicity and predictable pharmacokinetics. These properties have an established record in the management of pain in a variety of settings, particularly acute pain and breakthrough cancer pain. Fentanyl was initially developed for parenteral use; however, this is invasive and impractical in the outpatient setting. Unfortunately, the high first-pass metabolism of fentanyl makes oral formulations unfeasible...
March 23, 2017: Drugs
https://www.readbyqxmd.com/read/28336024/postoperative-pain-self-management-behavior-in-patients-who-underwent-total-knee-or-hip-arthroplasty
#4
Ning-Ning Zhu, Pei-Pei Xu, Ting-Ting Lei, Ting Sun, Sally Wai-Chi Chan
The self-management of acute postoperative pain is not well researched. This cross-sectional study investigates postoperative pain and pain self-management behavior. We recruited 127 patients who underwent total knee or total hip arthroplasty in an acute care hospital. We measured postoperative pain intensity and pain self-management behavior for three postoperative days. The results showed that the participants experienced mild and moderate pain intensity and perceived moderate to severe pain interference, which influenced their mood, sleep patterns, ability to walk, and performance of general activities and rehabilitation exercises...
April 2017: AORN Journal
https://www.readbyqxmd.com/read/28333667/effect-of-penetration-enhancers-on-the-percutaneous-delivery-of-pain-management-actives
#5
John Trimble, Bob Light
Transdermal compositions for pain management are comprised of nonsteroidal anti-inflammatory drugs, opioid drugs, and adjuvant drugs acting on: voltage-gated channels, gamma-aminobutyric acid receptors, acute musculoskeletal pain, and as an antidepressant. In this work, baclofen, bupivacaine, cyclobenzaprine, diclofenac, gabapentin, ibuprofen, ketamine, and pentoxifylline were loaded in transdermal compositions, prepared using a mixture of lipids (isopropyl palmitate and mineral oil) and one of two selected penetration enhancer mixtures: alkyl dimethicone, phenyl trimethicone, and polyoxyethylene sorbitan monostearate; and cetostearyl polyoxyethylene ether and ethylene oxide/propylene oxide copolymer...
May 2016: International Journal of Pharmaceutical Compounding
https://www.readbyqxmd.com/read/28333326/new-high-dose-pulsed-hyaluronidase-protocol-for-hyaluronic-acid-filler-vascular-adverse-events
#6
Claudio DeLorenzi
The purpose of this article is to update the changes to the author's protocols used to manage acute filler related vascular events from those previously published in this journal. For lack of a better term, this new protocol has been called the High Dose Pulsed Hyaluronidase (HDPH) protocol for vascular embolic events with hyaluronic acid (HA) fillers. The initial protocol used involved many different modalities of treatment. The current protocol is exceedingly simple and involves solely the use of hyaluronidase in repeated high doses...
March 17, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28331873/rapid-corneal-thinning-and-perforated-ulcerative-keratitis-in-a-patient-with-relapsing-polychondritis
#7
Tracy Hiu Ting Lai, Nikki Far, Alvin Lerrmann Young, Vishal Jhanji
BACKGROUND: To report rapid corneal thinning and perforation in a case with relapsing polychondritis. CASE PRESENTATION: A 43 year-old male diagnosed with relapsing polychondritis suffered from bilateral scleritis, bilateral swelling of pinna, saddle nose and tracheal stenosis. The patient presented with right eye pain and redness for one month. Slit lamp examination of the right eye showed 80% peripheral corneal thinning between 3 and 7 o'clock. The best-corrected visual acuity (BCVA) was 1...
2017: Eye and Vision (London, England)
https://www.readbyqxmd.com/read/28329922/recurrent-abdominal-pain-after-laparoscopic-appendectomy
#8
Kwang Il Seo, Sung Eun Kim, Moo In Park, Seun Ja Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Jung Gu Park
Laparoscopic surgical approaches, compared with open surgical approaches, provide comparable clinical outcomes, but lower complications. Unfortunately, a rare complication-portomesenteric vein thrombosis-had been reported after laparoscopic surgery. A 42-year-old woman was referred our hospital for recurrent abdominal pain after laparoscopic appendectomy from acute appendicitis. It was determined that abdominal pain was due to postoperative superior mesenteric vein thrombus. A six-month anticoagulation therapy is an excellent treatment for superior mesenteric vein thrombus ...
March 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/28326938/mechanisms-of-nerve-growth-factor-signaling-in-bone-nociceptors-and-in-an-animal-model-of-inflammatory-bone-pain
#9
Sara Nencini, Mitchell Ringuet, Dong-Hyun Kim, Yu-Jen Chen, Claire Greenhill, Jason J Ivanusic
Sequestration of nerve growth factor has been used successfully in the management of pain in animal models of bone disease and in human osteoarthritis. However, the mechanisms of nerve growth factor-induced bone pain and its role in modulating inflammatory bone pain remain to be determined. In this study, we show that nerve growth factor receptors (TrkA and p75) and some other nerve growth factor-signaling molecules (TRPV1 and Nav1.8, but not Nav1.9) are expressed in substantial proportions of rat bone nociceptors...
January 2017: Molecular Pain
https://www.readbyqxmd.com/read/28326850/multimodal-analgesia-in-moderate-to-severe-pain-a-role-for-a-new-fixed-combination-of-dexketoprofen-and-tramadol
#10
Giustino Varrassi, Magdi Hanna, Giorgos Macheras, Antonio Montero, Antonio Montes Perez, Winfried Meissner, Serge Perrot, Carmelo Scarpignato
Untreated and undertreated pain represent one of the most pervasive health problems, which is worsening as the population ages and accrues risk for pain. Multiple treatment options are available, most of which have one mechanism of action, and cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety concerns. Another limitation of single-agent analgesia is that, in general, pain is due to multiple causes. Combining drugs from different classes, with different and complementary mechanism(s) of action, provides a better opportunity for effective analgesia at reduced doses of individual agents...
March 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28325612/cost-effectiveness-of-high-sensitivity-troponin-compared-to-conventional-troponin-among-patients-presenting-with-undifferentiated-chest-pain-a-trial-based-analysis
#11
Billingsley Kaambwa, Julie Ratcliffe, Matthew Horsfall, Carolyn Astley, Jonathan Karnon, Penelope Coates, Margaret Arstall, Christopher Zeitz, Matthew Worthley, John Beltrame, Derek P Chew
BACKGROUND: Patients with low and intermediate risk chest pain features comprise the greatest proportion presenting to emergency services for evaluation of suspected acute coronary syndromes (ACS). The efficient and timely identification of patients with these features remains a major challenge within clinical practice. Troponin assays are increasingly being used for the determination of risk among patients presenting with chest pain potentially facilitating more appropriate care. To date, no economic evaluation comparing high-sensitivity troponin T (hs-TnT) reporting to standard troponin T (c-TnT) reporting in the routine management of suspected ACS and based on longer-term clinical outcomes has been conducted...
March 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28323246/the-role-of-spinal-gabab-receptors-in-cancelr-induced-bone-pain-in-rats
#12
Ya-Qun Zhou, Shu-Ping Chen, Dai-Qiang Liu, Anne Manyande, Wen Zhang, Shao-Bing Yang, Bing-Rui Xiong, Qiao-Chu Fu, Zhen-Peng Song, Heike Rittner, Da-Wei Ye, Yu-Ke Tian
Cancer-induced bone pain (CIBP) remains a major challenge in advanced cancer patients due to our lack of understanding of its mechanisms. Previous studies have demonstrated the vital role of GABAB receptors (GABABRs) in regulating nociception and various neuropathic pain models have shown diminished activity of GABABRs. However, the role of spinal GABABRs in CIBP remains largely unknown. In this study, we investigated the specific cellular mechanisms of GABABRs in the development and maintenance of CIBP in rats...
March 18, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28318860/a-prospective-randomized-trial-comparing-liposomal-bupivacaine-vs-fascia-iliaca-compartment-block-for-postoperative-pain-control-in-total-hip-arthroplasty
#13
Molly A McGraw-Tatum, Michael T Groover, Nicole E George, John S Urse, Victor Heh
BACKGROUND: Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS). METHODS: We performed a prospective randomized, controlled study involving 79 patients undergoing elective THA between June 2015 and February 2016...
February 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28318323/sublingual-transdermal-and-intravenous-patient-controlled-analgesia-for-acute-post-operative-pain-systematic-literature-review-and-mixed-treatment-comparison
#14
Pablo Katz, Shweta Takyar, Pamela Palmer, Hiltrud Liedgens
OBJECTIVE: To conduct a systematic literature review (SLR) and quantitative analysis to assess the comparative efficacy and safety of the sufentanil sublingual tablet system (SSTS) against other available patient controlled analgesia (PCA) options for post-operative analgesia. METHODS: An SLR was conducted for studies published between 2004 and 2016. Due to study heterogeneity, subgroup analyses were conducted controlling for differences in imputation methods for missing values, baseline pain severity, and type of surgery...
March 20, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28318209/end-of-life-care-managing-common-symptoms
#15
REVIEW
Ross H Albert
Physicians should be proficient at managing symptoms as patients progress through the dying process. When possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than to treat an acute symptom. As swallowing function diminishes, medications are typically administered sublingually, transdermally, or via rectal suppository. Opiates are the medication of choice for the control of pain and dyspnea, which are common symptoms in the dying process. Delirium and agitation may be caused by reversible etiologies, which should be identified and treated when feasible...
March 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28316858/spontaneous-intramural-oesophageal-haematoma-in-a-patient-with-uncontrolled-hypertension-an-unusual-chest-pain-aetiology
#16
Samantha Cooray, Dionysios Dellaportas, Clifford Caruana, Andrew R Davies
Introduction. Spontaneous intramural oesophageal haematoma is a rare condition that usually occurs secondary to an acute or chronic coagulation disorder. The presenting complaint is often with retrosternal chest pain and most patients are initially investigated to exclude more common causes in the differential diagnosis, such as acute coronary syndromes. Severe life-threatening bleeding or perforation seldom, if ever, arises. Case Presentation. We present a case of spontaneous oesophageal haematoma which appears to have developed gradually in a 69-year-old female with uncontrolled hypertension and antiplatelet medication use...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28303297/acute-calcific-tendinopathy-of-the-popliteus-tendon-a-rare-case-diagnosed-using-a-multimodality-imaging-approach-and-treated-conservatively
#17
Cédric Doucet, Akshat Gotra, Santhosh Mauvva Venkatesh Reddy, Mathieu Boily
Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues...
March 16, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28302233/an-unusual-case-of-caecal-volvulus-due-to-appendicitis-successfully-managed-by-caecopexy
#18
Samiullah Bhatti, Mahmood Ayyaz Khan, Waris Farooka, Usman Ismat Butt, Usman Ali Rehman, Awais Amjad Malik
Caecal volvulus is a rare cause of intestinal obstruction. Caecal volvulus precipitated by acute appendicitis is even rarer. We report an unusual case of caecal volvulus with acute appendicitis as a cause. A 55-year female presented in surgical emergency with 3 days history of abdominal pain, distension and absolute constipation; and 2 days history of vomiting. Her past surgical history was significant for hysterectomy 5 years back. On examination, abdomen was distended and bowel sounds exaggerated. X-ray abdomen erect showed a single large air fluid level in the right hemiabdomen...
March 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28299231/chronic-osteoporotic-pain-in-mice-cutaneous-and-deep-musculoskeletal-pain-are-partially-independent-of-bone-resorption-and-differentially-sensitive-to-pharmacological-interventions
#19
Miyako Suzuki, Magali Millecamps, Lina Naso, Seiji Ohtori, Chisato Mori, Laura S Stone
Although the pathological changes in osteoporotic bones are well established, the characterization of the osteoporotic pain and its appropriate treatment are not fully elucidated. We investigated the behavioral signs of cutaneous and deep musculoskeletal pain and physical function; time-dependent changes in bone mineral density (BMD) and the emergence of the behavioral phenotype; and the effects of pharmacological interventions having different mechanisms of action (chronic intraperitoneal administration of pamidronate [0...
2017: Journal of Osteoporosis
https://www.readbyqxmd.com/read/28296725/preoperative-use-of-pregabalin-for-acute-pain-in-spine-surgery-a-meta-analysis-of-randomized-controlled-trials
#20
Hai-Liang Jiang, Shuang Huang, Jiang Song, Xiang Wang, Zhong-Shu Cao
BACKGROUND: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery. METHODS: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours...
March 2017: Medicine (Baltimore)
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