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Patient-controlled analgesia

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https://www.readbyqxmd.com/read/29040231/continuous-infraclavicular-brachial-block-versus-single-shot-nerve-block-for-distal-radius-surgery-a-prospective-randomized-control-trial
#1
Abhishek Ganta, David Ding, Nina Fisher, Jessica Lavery, Sudheer Jain, Nirmal Tejwani
OBJECTIVES: To compare the efficacy of an infraclaviclar single shot nerve block to a continuous infusion through an On Q infusion pump for rebound pain (between 12 to 24 hours post-operatively) and post operative narcotic analgesia requirements in distal radius fractures. DESIGN: Prospective Randomized Control Trial SETTINGS:: Performed at two hospitals affiliated with a large urban academic medical center PATIENTS:: Fifty patients undergoing operative fixation of distal radius fractures (OTA/AO type 23B/C) INTERVENTION:: Patients were randomized to receive either an infraclavicular block as a single shot (SSB group) or a continuous infusion through an On Q pump (On Q group) MAIN OUTCOME MEASURES:: Visual analog scale (0-10) pain levels and amount of pain medication taken RESULTS:: At all time points after discharge, mean post-operative pain scores were lower in the On Q group vs the SSB group but did not reach statistical significance...
September 1, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29035643/role-of-bone-modifying-agents-in-metastatic-breast-cancer-an-american-society-of-clinical-oncology-cancer-care-ontario-focused-guideline-update
#2
Catherine Van Poznak, Mark R Somerfield, William E Barlow, J Sybil Biermann, Linda D Bosserman, Mark J Clemons, Sukhbinder K Dhesy-Thind, Melissa S Dillmon, Andrea Eisen, Elizabeth S Frank, Reshma Jagsi, Rachel Jimenez, Richard L Theriault, Theodore A Vandenberg, Gary C Yee, Beverly Moy
Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases...
October 16, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29035177/use-of-epidural-analgesia-as-an-adjunct-in-elective-abdominal-wall-reconstruction-a-review-of-4983-cases
#3
Efstathios Karamanos, Sophie Dream, Anthony Falvo, Nathan Schmoekel, Aamir Siddiqui
CONTEXT: Use of epidural analgesia in patients undergoing elective abdominal wall reconstruction is common. OBJECTIVE: To assess the impact of epidural analgesia in patients undergoing abdominal wall reconstruction. DESIGN: All patients who underwent elective ventral hernia repair from 2005 to 2014 were retrospectively identified. Patients were divided into two groups by the postoperative use of epidural analgesics as an adjunct analgesic method...
2017: Permanente Journal
https://www.readbyqxmd.com/read/29033726/ultrasound-guided-multilevel-paravertebral-block-versus-local-anesthesia-for-medical-thoracoscopy
#4
Maha A Abo-Zeid, Mohammad M Elgamal, Asem A Hewidy, Amro A Moawad, Alaa Eldin Adel Elmaddawy
BACKGROUND: Local anesthetic infiltration for medical thoracoscopy has an analgesic properties for short duration. Single injection thoracic paravertebral block (PVB) provides limited analgesia. PURPOSE: Comparison between thoracic PVB performed at two or three levels with local infiltration for anesthetic adequacy in adult medical thoracoscopy as a primary outcome and postthoracoscopic analgesia and pulmonary function as secondary outcomes for adult medical thoracoscopy...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29033725/assessment-of-patient-controlled-analgesia-versus-intermittent-opioid-therapy-to-manage-sickle-cell-disease-vaso-occlusive-crisis-in-adult-patients
#5
Alaa Al-Anazi, Lowloa Al-Swaidan, Maha Al-Ammari, Tariq Al-Debasi, Abdulmalik M Alkatheri, Shmeylan Al-Harbi, Aiman A Obaidat, Abdulkareem M Al-Bekairy
BACKGROUND: Vaso-occlusive crisis (VOC) is one of the acute complications of sickle-cell disease (SCD). Treatment mainly relies on hydration and pain control by analgesics. The specific aim of this study was to assess potential health outcomes within the first 72 h of admission between intermittent and patient-controlled analgesia (PCA) by opioids among VOC patients. METHODS: A retrospective chart review study was conducted to determine SCD patients with VOC. Using the hospital electronic system, the following data were collected: patient's age, gender, blood pressure, heart rate, respiratory rate, oxygen saturation, and pain score on admission and daily for 3 days as well as the cumulative opioid analgesic dose for 72 h which is reported as morphine equivalent...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29033723/postoperative-pain-management-in-patients-undergoing-thoracoscopic-repair-of-pectus-excavatum-a-retrospective-analysis-of-opioid-consumption-and-adverse-effects-in-adolescents
#6
Ralph Beltran, Giorgio Veneziano, Tarun Bhalla, Brian Kenney, Dmitry Tumin, Bruno Bissonnette, Joseph D Tobias
INTRODUCTION: Although the Nuss procedure provides excellent cosmetic results for the correction of pectus excavatum, the provision of analgesia following such procedures can be challenging. METHODS: The current study retrospectively reviews our experience over a 2.5 year period with thoracic epidural analgesia (TE), paravertebral blockade (PVB), and intravenous opioids delivered via patient-controlled analgesia (PCA) to provide postoperative analgesia. RESULTS: The study cohort included 30 patients (mean age = 15...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29033716/transdermal-fentanyl-as-an-adjuvant-to-paravertebral-block-for-pain-control-after-breast-cancer-surgery-a-randomized-double-blind-controlled-trial
#7
Ahmed H Bakeer, Nasr M Abdallah
OBJECTIVE: The aim of this study is to investigate the effect of transdermal fentanyl (TDF) as an adjuvant to paravertebral block (PVB) for pain control after breast cancer surgery. PATIENTS AND METHODS: This randomized, double-blind trial included fifty females with breast cancer scheduled for surgery. They were randomly allocated into one of two equal groups. The TDF group used transdermal fentanyl patches (TFPs) 25 μg/h applied 10 h preoperative then PVB with 20 mL of bupivacaine 0...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29033356/intraoperative-analgesia-guided-by-the-analgesia-nociception-index-in-bariatric-surgery-an-unmatched-case-control-study
#8
Lisa Le Gall, Anaëlle David, Pauline Carles, Sébastien Leuillet, Brigitte Chastel, Catherine Fleureau, Antoine Dewitte, Alexandre Ouattara
INTRODUCTION: Analgesia Nociception Index (ANI) has been proposed for the evaluation of the nociception-antinociception balance in the perioperative period. In obese patient, where the management of analgesia may be rendered difficult by pharmacological changes, we hypothesized that the monitoring of analgesia with ANI would reduce intraoperative opioid consumption during bariatric surgery. METHODS: This monocentric, observational, unmatched case-control study aimed to compare perioperative data from obese subjects (body mass index ≥ 35kg...
October 12, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29033355/evaluation-of-the-effect-of-serratus-anterior-plane-block-for-pain-treatment-after-video-assisted-thoracoscopic-surgery
#9
Korgun Okmen, Burcu Metin Okmen
BACKGROUND: Analgesia following video-assisted thoracoscopic surgery (VATS) is important for the prevention of postoperative pulmonary complications. Various regional methods of anaesthesia are currently being used to achieve this goal. In our study, we aim to assess the effectiveness of SAPB on postoperative VATS analgesia in our study. METHODS: A total of 40 patients aged between 18 and 70 years, those who were in the Society of Anaesthesiologists (ASA) I-III class and underwent VATS were included in the study...
October 12, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29029797/comparison-of-intravenous-dexketoprofen-trometamol-fentanyl-and-paracetamol-in-the-treatment-of-patients-admitted-to-the-emergency-department-for-renal-colic-a-randomized-controlled-trial
#10
Behcet Al, Mehmet Mustafa Sunar, Suat Zengin, Mustafa Sabak, Mustafa Bogan, Basri Can, Seval Kul, M Murat Oktay, Sevki Hakan Eren
OBJECTIVE: In this study, we aimed to compare the analgesic efficacy of intravenous dexketoprofen trometamol, fentanyl, and paracetamol in patients presenting to the emergency department with renal colic. MATERIALS AND METHOD: Data obtained from the emergency departments of Gaziantep University's Hospital for Research and Practice along with two other state hospitals in Gaziantep, Turkey between January 2016 and January 2017 was used for this study. A total of three hundred patients (n=300), who presented to the ER with complaints most common to renal colic whose diagnoses were subsequently confirmed with Computerized Tomography were included in the study...
September 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29029049/intraoperative-naloxone-reduces-remifentanil-induced-postoperative-hyperalgesia-but-not-pain-a-randomized-controlled-trial
#11
C-H Koo, S Yoon, B-R Kim, Y J Cho, T K Kim, Y Jeon, J-H Seo
Background: Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone. Methods: Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0...
October 3, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29028436/pain-management-after-hip-arthroscopy-systematic-review-of-randomized-controlled-trials-and-cohort-studies
#12
Jason J Shin, Chris L McCrum, Craig S Mauro, Dharmesh Vyas
BACKGROUND: Hip arthroscopy is often associated with significant postoperative pain and opioid-associated side effects. Effective pain management after hip arthroscopy improves patient recovery and satisfaction and decreases opioid-related complications. PURPOSE: To collect, examine, and provide a comprehensive review of the available evidence from randomized controlled trials and comparative studies on pain control after hip arthroscopy. STUDY DESIGN: Systematic review...
October 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/29027771/two-different-placement-paths-in-popliteal-fossa-with-a-novel-nerve-block-needle-with-external-indwelling-cannula-for-postoperative-analgesia-after-foot-and-ankle-surgery-a-randomized-controlled-trial
#13
Miao He, Dandan Ling, Guang-Yu Cai, Tian-Xiao Zou, Bin Yu
BACKGROUND: Previous studies have documented that single injection nearby the sciatic nerve bifurcation would influence the anesthesia and analgesia effect. But this is uncertain for preoperative continuous popliteal sciatic nerve block. So we conducted this trial to compare two paths (proximal to the bifurcation and at the bifurcation) of ultrasound guided continuous popliteal sciatic nerve block in foot and ankle surgery. METHODS: 40 recruited objects were randomly assigned to receive ultrasound-guided continuous popliteal sciatic nerve block at the puncture path proximal to the nerve bifurcation either at the nerve bifurcation...
October 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29026354/novel-regional-techniques-for-total-knee-arthroplasty-promote-reduced-hospital-length-of-stay-an-analysis-of-106-patients
#14
Salman Thobhani, Lauren Scalercio, Clint E Elliott, Bobby D Nossaman, Leslie C Thomas, Dane Yuratich, Kim Bland, Kristie Osteen, Matthew E Patterson
BACKGROUND: Novel regional techniques, including the adductor canal block (ACB) and the local anesthetic infiltration between the popliteal artery and capsule of the knee (IPACK) block, provide an alternative approach for controlling pain following total knee arthroplasty (TKA). This study compared 3 regional techniques (femoral nerve catheter [FNC] block alone, FNC block with IPACK, and ACB with IPACK) on pain scores, opioid consumption, performance during physical therapy, and hospital length of stay in patients undergoing TKA...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/29026331/poorly-controlled-postoperative-pain-prevalence-consequences-and-prevention
#15
REVIEW
Tong J Gan
This review provides an overview of the clinical issue of poorly controlled postoperative pain and therapeutic approaches that may help to address this common unresolved health-care challenge. Postoperative pain is not adequately managed in greater than 80% of patients in the US, although rates vary depending on such factors as type of surgery performed, analgesic/anesthetic intervention used, and time elapsed after surgery. Poorly controlled acute postoperative pain is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29026330/parecoxib-relieves-pain-and-has-an-opioid-sparing-effect-following-major-gastrointestinal-surgery
#16
Margaret Noyes Essex, Hao Xu, Bruce Parsons, Li Xie, Chunming Li
PURPOSE: Parecoxib provides analgesia following a variety of surgeries, including minor gastrointestinal procedures. To our knowledge, there is no data on parecoxib following major gastrointestinal surgery. This study assessed the efficacy and opioid-sparing effects of parecoxib following major gastrointestinal surgeries. PATIENTS AND METHODS: Patients in this analysis were a subset from a large, randomized, double-blind, placebo-controlled trial of parecoxib following noncardiac surgeries and consisted of those undergoing a variety of major gastrointestinal surgeries via laparotomy...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/29025135/current-perspective-on-the-use-of-opioids-in-perioperative-medicine-an-evidence-based-literature-review-national-survey-of-70-000-physicians-and-multidisciplinary-clinical-appraisal
#17
Jonathan S Jahr, Sergio D Bergese, Ketan R Sheth, Nicholas M Bernthal, Hung S Ho, Nicoleta Stoicea, Christian C Apfel
Objective: Opioids represent an important analgesic option for physicians managing acute pain in surgical patients. Opioid management is not without its drawbacks, however, and current trends suggest that opioids might be overused in the United States. An expert panel was convened to conduct a clinical appraisal regarding the use of opioids in the perioperative setting. Methods: The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the statement "Opioids are not overused in the United States, even though opioid adjunct therapy achieves greater pain control with less risk...
August 16, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29024230/%C3%AE-aminobutyric-acid-gaba-oral-rinse-reduces-capsaicin-induced-burning-mouth-pain-sensation-an-experimental-quantitative-sensory-testing-study-in-healthy-subjects
#18
Y Zhang, K Wang, L Arendt-Nielsen, B E Cairns
BACKGROUND: In burning mouth patients, analgesia after oral administration of clonazepam may result from modulation of peripheral γ-aminobutyric acid (GABA) receptors. METHODS: The effect of oral administration of test solutions (water, 0.5 mol/L or 0.05 mol/L GABA, 1% lidocaine) was investigated for the amelioration of pain and sensitivity induced by application of capsaicin (1%, 2 min) to the tongue of thirty healthy male and female subjects in this four-session, randomized, placebo-controlled, double-blinded, cross-over study...
October 11, 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/29019421/management-of-acute-pain-in-the-postoperative-setting-the-importance-of-quality-indicators
#19
Winfried Meissner, Frank Huygen, Edmund A M Neugebauer, Jürgen Osterbrink, Dan Benhamou, Neil Betteridge, Flaminia Coluzzi, José De Andres, William Fawcett, Dominique Fletcher, Eija Kalso, Henrik Kehlet, Bart Morlion, Antonio Montes Pérez, Joseph Pergolizzi, Michael Schäfer
Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care provided to patients...
October 11, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29016552/the-efficacy-of-peripheral-opioid-antagonists-in-opioid-induced-constipation-and-postoperative-ileus-a-systematic-review-of-the-literature
#20
Eric S Schwenk, Alexander E Grant, Marc C Torjman, Stephen E McNulty, Jaime L Baratta, Eugene R Viscusi
Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective μ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting μ-opioid receptor antagonists target the μ-opioid receptor without reversing analgesia...
October 6, 2017: Regional Anesthesia and Pain Medicine
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