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multimodal analgesia

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https://www.readbyqxmd.com/read/28339433/management-of-neuropathic-chronic-pain-with-methadone-combined-with-ketamine-a-randomized-double-blind-active-controlled-clinical-trial
#1
Flavia Karine Rigo, Gabriela Trevisan, Maria C Godoy, Mateus Fortes Rossato, Gerusa D Dalmolin, Mariane A Silva, Mirian S Menezes, Wolnei Caumo, Juliano Ferreira
BACKGROUND: Methadone and ketamine are used in neuropathic pain management. However, the benefits of both drugs association are uncertain in the treatment of neuropathic pain. OBJECTIVE: Our primary objective was test the hypothesis that oral methadone combined with oral ketamine is more effective than oral methadone or ketamine alone in reducing neuropathic pain. STUDY DESIGN: We conducted a randomized, double blind, active-controlled parallel-group clinical trial...
March 2017: Pain Physician
https://www.readbyqxmd.com/read/28339431/perioperative-ketamine-administration-for-thoracotomy-pain
#2
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/28338159/-application-of-multimodal-analgesia-in-radical-gastrectomy-for-gastric-cancer-patients-a-prospective-nonrandomized-controlled-study
#3
Wei Zhang, Ka Li, Weihan Zhang, Fei Liu, Kai Liu, Xiaohai Song, Xinzu Chen, Kun Yang, Jiankun Hu
OBJECTIVE: To compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients. METHODS: Patients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University...
March 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28333865/clinical-application-of-perioperative-multimodal-analgesia
#4
Jörgen Bruhn, Gert J Scheffer, Geert-Jan van Geffen
PURPOSE OF REVIEW: The experience of intense postoperative pain remains a significant problem in perioperative medicine. The mainstay of postoperative analgetic therapy is the combination of nonopioid agents (e.g. paracetamol and NSAIDs) with strong opioids (e.g. morphine) according to the WHO analgesic ladder. But as the incidence and intensity of postoperative pain remains high, the search for and evaluation of additional concepts is ongoing. This review highlights the current trends of perioperative multimodal analgesia concepts...
March 22, 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#5
REVIEW
Zachary A Turnbull, Dahniel Sastow, Gregory P Giambrone, Tiffany Tedore
Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28326850/multimodal-analgesia-in-moderate-to-severe-pain-a-role-for-a-new-fixed-combination-of-dexketoprofen-and-tramadol
#6
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/28321141/adjunct-analgesic-use-for-acute-pain-in-the-emergency-department
#7
James Priano, Brian Faley, Gabrielle Procopio, Kevin Hewitt, Joseph Feldman
Purpose: Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups...
February 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28314303/enhanced-recovery-after-surgery-programs-for-laparoscopic-colorectal-resection-may-not-need-thoracic-epidural-analgesia
#8
Ken Eto, Ichiro Kondo, Makoto Kosuge, Masahisa Ohkuma, Koichiro Haruki, Kai Neki, Hiroshi Sugano, Ryosuke Hashizume, Katsuhiko Yanaga
BACKGROUND/AIM: The aim of this study was to evaluate the necessity of thoracic epidural analgesia (TEA) as enhanced recovery after surgery (ERAS) programs for laparoscopic colorectal surgery (LC). PATIENTS AND METHODS: We retrospectively compared between perioperative outcomes of patients who underwent LC with TEA (n=31) and with multimodal analgesia (MMA) (n=31). Furthermore, we also evaluated the patients' satisfaction by a questionnaire survey to the nurses...
March 2017: Anticancer Research
https://www.readbyqxmd.com/read/28298781/analgesic-efficacy-of-transverse-abdominal-plane-block-after-elective-cesarean-delivery-bupivacaine-with-fentanyl-versus-bupivacaine-alone-a-randomized-double-blind-controlled-clinical-trial
#9
Roshan John, R V Ranjan, T R Ramachandran, Sagiev Koshy George
BACKGROUND: The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery remains controversial. In our study, we compared the analgesic efficacy of TAP block using local anesthetic bupivacaine and adjunct fentanyl with bupivacaine alone in patients undergoing elective cesarean section. METHODS: Our study was a randomized, double-blind, controlled clinical trial where sixty patients undergoing elective cesarean delivery under subarachanoid block (2 ml of 0...
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28296770/evaluation-of-intrathecal-drug-delivery-system-for-intractable-pain-in-advanced-malignancies-a-prospective-cohort-study
#10
Shuyue Zheng, Liangliang He, Xiaohui Yang, Xiuhua Li, Zhanmin Yang
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28293525/surgical-site-infiltration-for-abdominal-surgery-a-novel-neuroanatomical-based-approach
#11
Girish P Joshi, Jeffrey E Janis, Eric M Haas, Bruce J Ramshaw, Mikio A Nihira, Brian J Dunkin
BACKGROUND: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. METHODS: Literature searches were conducted for studies reporting the neuroanatomical sources of pain after abdominal surgery...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28291185/efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized-controlled-trial
#12
Daniel Koehler, J Lawrence Marsh, Matthew Karam, Catherine Fruehling, Michael Willey
BACKGROUND: Multimodal analgesia inclusive of periarticular injection with a local anesthetic agent has been rapidly assimilated, with demonstrated safety and efficacy, into the care of patients undergoing elective lower-extremity arthroplasty. The present study was performed to evaluate the efficacy and safety of a surgical-site, multimodal drug injection for postoperative pain control following operative management of femoral fractures. METHODS: There were 102 patients undergoing operative intervention (plate fixation, intramedullary device, or arthroplasty) for a broad range of femoral fracture patterns who were prospectively randomized either to receive an intraoperative, surgical-site injection into the superficial and deep tissues containing ropivacaine, epinephrine, and morphine or to receive no injection...
March 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28291143/the-role-of-multimodal-analgesia-in-spine-surgery
#13
Mark F Kurd, Tyler Kreitz, Gregory Schroeder, Alexander R Vaccaro
Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay...
April 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28283811/techniques-to-optimize-multimodal-analgesia-in-ambulatory-surgery
#14
REVIEW
Amit Prabhakar, John N Cefalu, Josef S Rowe, Alan D Kaye, Richard D Urman
PURPOSE OF REVIEW: Ambulatory surgery has grown in popularity in recent decades due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. We review common approaches to multimodal analgesia. RECENT FINDINGS: A multimodal approach can help reduce perioperative opioid requirements and improve patient recovery. Analgesic options may include NSAIDs, acetaminophen, gabapentinoids, corticosteroids, alpha-2 agonists, local anesthetics, and the use of regional anesthesia...
May 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28277866/treatment-for-chronic-low-back-pain-the-focus-should-change-to-multimodal-management-that-reflects-the-underlying-pain-mechanisms
#15
Gerhard Müller-Schwefe, Bart Morlion, Karsten Ahlbeck, Eli Alon, Stefano Coaccioli, Flaminia Coluzzi, Frank Huygen, Wolfgang Jaksch, Eija Kalso, Magdalena Kocot-Kępska, Hans-Georg Kress, Ana Cristina Mangas, Cesar Margarit Ferri, Philippe Mavrocordatos, Andrew Nicolaou, Concepción Pérez Hernández, Joseph Pergolizzi, Michael Schäfer, Patrick Sichère
Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed...
March 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28277593/pain-management-with-adductor-canal-blockade-or-multimodal-periarticular-analgesia-in-elderly-total-knee-arthroplasty-patients
#16
Chukwuweike U Gwam, Nequesha Mohamed, Jaydev B Mistry, Melbin Thomas, Morad Chughtai, Sabahat Khan, Anton Khlopas, Michael A Mont, Ronald E Delanois
INTRODUCTION: Post-operative pain management in elderly total knee arthroplasty (TKA) patients has traditionally included opioids, epidurals, and femoral nerve blocks. Although these modalities are effective, they are often associated with adverse side effects, which may have a greater impact on this population. Alternative modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA) have demonstrated great efficacy with a low side effect profile. However, it is unknown if one modality is advantageous over the other in the elderly...
March 9, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28267070/adherence-to-a-multimodal-analgesic-clinical-pathway-a-within-group-comparison-of-staged-bilateral-knee-arthroplasty-patients
#17
Rachel C Steckelberg, Natasha Funck, T Edward Kim, Tessa L Walters, Gregory Milo Lochbaum, Stavros G Memtsoudis, Nicholas J Giori, Pier F Indelli, Lorrie J Graham, Edward R Mariano
BACKGROUND AND OBJECTIVES: Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing staged bilateral procedures. METHODS: This study was performed at a hospital with a Perioperative Surgical Home program and knee arthroplasty clinical pathway using multimodal analgesia and adductor canal catheters...
March 6, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28265859/new-cancer-pain-treatment-options
#18
REVIEW
Kenneth D Candido, Teresa M Kusper, Nebojsa Nick Knezevic
PURPOSE OF REVIEW: Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28252817/postoperative-pain-experiences-in-chinese-adult-patients-after-thoracotomy-and-video-assisted-thoracic-surgery
#19
Hui Wang, Shanqing Li, Naixin Liang, Wei Liu, Hongju Liu, Huaping Liu
AIMS AND OBJECTIVES: To investigate the developing course of postoperative pain in a Chinese sample of patients following thoracic surgery. BACKGROUND: Chronic post operative pain following thoracic surgery including both thoracotomy and video-assisted thoracic surgery is often reported. However, research on pain trends concerning this topic are scarce with a notable lack of culturally focused studies by nurses. DESIGN: A prospective observational study...
March 2, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28251525/updates-in-pediatric-regional-anesthesia-and-its-role-in-the-treatment-of-acute-pain-in-the-ambulatory-setting
#20
REVIEW
Alecia L S Stein, Dorothea Baumgard, Isis Del Rio, Jacqueline L Tutiven
PURPOSE OF REVIEW: The purpose of this review is to summarize the latest advances in pediatric regional anesthesia with special emphasis on its role in the ambulatory surgical setting. RECENT FINDINGS: Undertreated pain in children following ambulatory surgery is not a rare occurrence and it is associated with increased morbidity and significant psychosocial harm. Use of regional anesthesia as part of the anesthetic approach in the ambulatory setting is safe when performed on children under general anesthesia and inclusion of certain adjuncts improves block outcomes...
February 2017: Current Pain and Headache Reports
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