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multimodal pain management

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https://www.readbyqxmd.com/read/27904951/pre-emptive-injection-of-peri-articular-multimodal-drug-for-post-operative-pain-management-in-total-knee-arthroplasty-a-double-blind-randomized-clinical-trial
#1
Mahdi Motififard, Ali Omidian, Sajad Badiei
PURPOSE: Severe post-operative pain is one of the main problems after total knee arthroplasty. In this study, we investigated the effect of a peri-articular multimodal drugs injections pre-emptively on post-operative pain control and knee functions following total knee arthroplasty. METHODS AND MATERIALS: This study was a double-blind randomized clinical trial. Eligible cases including 137 patients-aged 30 to 80 years old-were randomly divided into one of two groups: the drug group received a cocktail consisting of bupivacaine hydrochloride, morphine sulphate, epinephrine, and ketorolac...
November 30, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27898461/cold-pain-threshold-identifies-a-subgroup-of-patients-with-knee-osteoarthritis-that-present-with-multimodality-hyperalgesia-and-elevated-pain-levels
#2
Anthony Wright, Heather A E Benson, Rob Will, Penny Moss
OBJECTIVES: Cold hyperalgesia has been established as an important marker of pain severity in a number of conditions. This study aimed to establish the extent to which patients with knee osteoarthritis (OA) demonstrate widespread cold, heat, and pressure hyperalgesia. OA participants with widespread cold hyperalgesia were compared with the remaining OA cohort to determine whether they could be distinguished in terms of hyperalgesia, pain report, pain quality, and physical function. METHODS: A total of 80 participants with knee OA and 40 matched healthy controls participated...
November 24, 2016: Clinical Journal of Pain
https://www.readbyqxmd.com/read/27898134/quality-pain-care-for-older-adults-in-an-era-of-suspicion-and-scrutiny
#3
Barbara St Marie, Paul Arnstein
In two decades, the pendulum has swung from focusing on the undertreatment of pain by prescribers who fail to use medically necessary opioid agents to an intense focus on overprescribing opioid medications and the harms they cause. Within these two extremes rests the older adult with pain and in need of safe and effective care. Today, health care providers are practicing in an era of scrutiny, with new guidelines and regulations superseding their compassion and clinical judgment about the best treatment options when older adults have pain across the care continuum...
December 1, 2016: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/27886697/nonsurgical-management-of-osteoarthritis-knee-pain-in-the-older-adult
#4
REVIEW
Nora Taylor
Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners' understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacologic and pharmacologic therapies to achieve a maximal clinical benefit. The focus of this review is on the nonsurgical options for treatment of knee osteoarthritis in patients aged 65 and older...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27884220/multimodal-pain-management-for%C3%A2-enhanced-recovery-reinforcing-the-shift-from-traditional-pathways-through-nurse-led-interventions
#5
Robert Montgomery, Sharon A McNamara
Despite recent advances in perioperative patient care, postsurgical pain continues to be undermanaged. There is increasing acceptance of the concept that effective postsurgical pain management is best achieved through combined use of more than one analgesic agent or technique, and overreliance on opioids produces unwanted side effects limiting their utility. Accordingly, a balanced, multimodal approach to pain management within the larger framework of an Enhanced Recovery After Surgery (ERAS) pathway has become standard at many institutions for perioperative care, to control postsurgical pain, reduce opioid-related adverse events, hasten postsurgical recovery, and shorten length of hospital stay...
December 2016: AORN Journal
https://www.readbyqxmd.com/read/27879573/multimodal-analgesia-versus-intravenous-patient-controlled-analgesia-for-minimally-invasive-transforaminal-lumbar-interbody-fusion-procedures
#6
Kern Singh, Daniel D Bohl, Junyoung Ahn, Dustin H Massel, Benjamin C Mayo, Ankur S Narain, Fady Y Hijji, Philip K Louie, William W Long, Krishna D Modi, Tae D Kim, Krishna T Kudaravalli, Frank M Phillips, Asokumar Buvanendran
STUDY DESIGN: Retrospective analysis. OBJECTIVE: To compare postoperative narcotic consumption and pain scores between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA: A multimodal analgesic approach to pain management may lead to decreased pain and narcotic consumption following orthopaedic procedures. However, additional evidence is required to determine how MMA compares to intravenous (IV) PCA following MIS TLIF...
November 22, 2016: Spine
https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#7
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27870668/cost-savings-opportunities-in-perioperative-management-of-the-patients-with-orthopaedic-trauma
#8
Alastair E Moody, Catriona E Moody, Peter L Althausen
Considerable opportunities for cost savings exist surrounding the perioperative management of patients with orthopaedic fracture and trauma. Scientific evidence is available to support each potential cost savings measure. Much of these data had been documented for years but has never been adhered to, resulting in millions of dollars in unnecessary testing and treatment. Careful attention to preoperative laboratory testing can save huge amounts of money and expedite medical clearance for injured patients. The use of a dedicated orthopaedic trauma operating room has been shown to improve resource utilization, decrease costs, and surgical complications...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27867510/effect-of-adding-intrathecal-morphine-to-a-multimodal-analgesic-regimen-for-postoperative-pain-management-after-laparoscopic-bariatric-surgery-a-prospective-double-blind-randomized-controlled-trial
#9
Fatma Adel El Sherif, Ahmed Hassan Othman, Ahmad Mohammad Abd El-Rahman, Osama Taha
BACKGROUND: Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery. METHODS: After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0...
November 2016: British Journal of Pain
https://www.readbyqxmd.com/read/27856266/local-injection-of-liposomal-bupivacaine-combined-with-intravenous-dexamethasone-reduces-postoperative-pain-and-hospital-stay-after-shoulder-arthroplasty
#10
Howard D Routman, Logan R Israel, Molly A Moor, Andrew D Boltuch
BACKGROUND: Alternative techniques have been developed to address pain after shoulder arthroplasty and are well documented. We evaluated the effect of adding intraoperative liposomal bupivacaine and intravenous dexamethasone during shoulder arthroplasty. METHODS: We retrospectively reviewed 2 consecutive cohorts undergoing elective shoulder arthroplasty. The 24 patients in cohort 1 and the 31 patients in cohort 2 received perioperative multimodal management with preoperative and postoperative intravenous and oral narcotics, gabapentin, nonsteroidal anti-inflammatory drugs, acetaminophen, and single-injection interscalene block...
November 15, 2016: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/27851205/1570-multimodal-pain-management-in-total-knee-replacement-with-or-without-intravenous-acetaminophen
#11
Francesco Ciummo, Eunah Cheon, Joseph Samide, Helen Habib, Teena Abraham, Henry Tischler
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27847695/combined-ketamine-tramadol-subcutaneous-wound-infiltration-for-multimodal-postoperative-analgesia-a-double-blinded-randomized-controlled-trial-after-renal-surgery
#12
Mohammad Reza Khajavi, Marzieh Navardi, Reza Shariat Moharari, Pejman Pourfakhr, Narjes Khalili, Farhad Etezadi, Farsad Imani
BACKGROUND: Pain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery. OBJECTIVES: The aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain. METHODS: Sixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study...
October 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27845483/prevalence-of-pain-in-the-departments-of-surgery-and-oncohematology-of-a-paediatric-hospital-that-has-joined-the-project-towards-pain-free-hospital
#13
G Marchetti, A Vittori, V Tortora, M Bishop, G Lofino, V Pardi, E A De Marco, G Manca, A Inserra, R Caruso, I Ciaralli, F Locatelli, S Bella, A E Tozzi, S Picardo
BACKGROUND: Among hospitalized adults and children pain is undertreated. This study wants to assess the effectiveness of pain therapy in two departments of a large children's hospital. MATERIALS AND METHODS: During a single day work three committees, administering a questionnaire to patients or parents, have evaluated the adherence to international recommendations (JCI and WHO) in the management of analgesic therapy. Patient demographics, prevalence and intensity (moderate and/or severe) of pain (during hospitalization, 24 hours before and at the time of the interview), analgesia (type, route, duration and frequency of administration) and Pain Management Index (=analgesic score-pain score) were recorded...
September 2016: La Clinica Terapeutica
https://www.readbyqxmd.com/read/27836071/the-treatment-of-neck-pain-associated-disorders-and-whiplash-associated-disorders-a-clinical-practice-guideline
#14
André E Bussières, Gregory Stewart, Fadi Al-Zoubi, Philip Decina, Martin Descarreaux, Jill Hayden, Brenda Hendrickson, Cesar Hincapié, Isabelle Pagé, Steven Passmore, John Srbely, Maja Stupar, Joel Weisberg, Joseph Ornelas
OBJECTIVE: The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. METHODS: Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials...
October 2016: Journal of Manipulative and Physiological Therapeutics
https://www.readbyqxmd.com/read/27828892/exploring-opioid-sparing-multimodal-analgesia-options-in-trauma-a-nursing-perspective
#15
Denise Sullivan, Mary Lyons, Robert Montgomery, Ann Quinlan-Colwell
Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma...
November 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/27828796/perioperative-anesthesia-care-and-tumor-progression
#16
Mir W Sekandarzad, André A J van Zundert, Philipp B Lirk, Chris W Doornebal, Markus W Hollmann
This narrative review discusses the most recent up-to-date findings focused on the currently available "best clinical practice" regarding perioperative anesthesia care bundle factors and their effect on tumor progression. The main objective is to critically appraise the current literature on local anesthetics, regional outcome studies, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs) and their ability to decrease recurrence in patients undergoing cancer surgery. A brief discussion of additional topical perioperative factors relevant to the anesthesiologist including volatile and intravenous anesthetics, perioperative stress and anxiety, nutrition, and immune stimulation is included...
November 8, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27820738/an-update-on-pain-management-for-elderly-patients-undergoing-ambulatory-surgery
#17
Xuezhao Cao, Ofelia L Elvir-Lazo, Paul F White, Roya Yumul, Jun Tang
PURPOSE OF REVIEW: The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting. RECENT FINDINGS: Interest has grown in the possibility of adding adjuncts to a single shot nerve block in order to prolong the local anesthetic effect. The rapid and short-acting local anesthetics for spinal anesthesia are potentially beneficial for day-case surgery in the older population because of shorter duration of the motor block, faster recovery, and less transient neurologic symptoms...
December 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27816114/integrated-imaging-in-hypertrophic-cardiomyopathy
#18
REVIEW
Lubna Choudhury, Vera H Rigolin, Robert O Bonow
Hypertrophic cardiomyopathy (HC) has a very heterogeneous clinical spectrum and lends itself to multimodality imaging for evaluation and management. This review addresses clinical applications of cardiac imaging in patients with HC. Integrating various techniques of echocardiography and cardiac magnetic resonance (CMR) is discussed in the clinical context such as diagnosis, evaluation, management, risk stratification, and family screening of patients with HC. The utility of periprocedural imaging techniques is highlighted for guiding surgical and transcatheter septal reduction procedures...
October 11, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27798932/clinical-presentation-magnetic-resonance-angiography-ultrasound-findings-and-stroke-patterns-in-patients-with-vertebral-artery-dissection
#19
Albrecht Günther, Otto W Witte, Martin Freesmeyer, Robert Drescher
BACKGROUND/AIMS: Vertebral artery dissection (VAD) is an important cause of ischemic stroke. In this observational study, clinical data, magnetic resonance (MR) and ultrasound (US) imaging findings and ischemic patterns were analyzed. METHODS: Forty-seven patients with a diagnosis of VAD underwent clinical examination, US, MR of the brain and neck and MR angiography (MRA) of the cervical arteries. Vascular abnormalities and ischemic brain lesions were noted. Data were evaluated separately and compared for spontaneous and traumatic VAD subgroups...
2016: European Neurology
https://www.readbyqxmd.com/read/27785937/paracetamol-and-morphine-for-infant-and-neonatal-pain-still-a-long-way-to-go
#20
Manuel A Baarslag, Karel Allegaert, John N Van Den Anker, Catherijne A J Knibbe, Monique Van Dijk, Sinno H P Simons, Dick Tibboel
Pharmacologic pain management in newborns and infants is often based on limited scientific data. To close the knowledge gap, drug-related research in this population is increasingly supported by the authorities, but remains very challenging. This review summarizes the challenges of analgesic studies in newborns and infants on morphine and paracetamol (acetaminophen). Areas covered: Aspects such as the definition and multimodal character of pain are reflected to newborn infants. Specific problems addressed include defining pharmacodynamic endpoints, performing clinical trials in this population and assessing developmental changes in both pharmacokinetics and pharmacodynamics...
November 9, 2016: Expert Review of Clinical Pharmacology
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