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Latest & greatest articles for analgesia
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Analgesic drugs are used to provide analgesia, the inability to feel pain. There are numerous groups of analgesics including simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Analgesics types are prescribed differently depending on the severity of pain relief needed.
The most common type of analgesic generally known and used is non-steroidal anti-inflammatory drugs such as paracetamol, aspirin and ibuprofen. Opioid drugs include morphine, codeine, oxycodone, dihydromorphine and pethidine.
Research shows that analgesic drugs have an effect on the peripheral and central nervous system, relieving pain without the loss of consciousness. Opioids are highly effect pain relievers however case studies prove they can be highly addictive. Therefore use should be guided by the World Health Organization (WHO) pain ladder which specifies mild analgesics as its first step.
Clinical trials and studies carried out across all groups of analgesia have proven the drugs are highly effective painkillers, opioids in particular. However, years of research and clinical trials conclude that some groups have significant side effects such as addiction or cardiovascular side effects. Research evidence is broad including clinical guidelines, systematic reviews, randomised controlled trials, case studies etc. These can easily be found via a search of the Trip Database.
Effect of bilateral scalp nerve blocks on postoperative pain and discharge times in patients undergoing supratentorial craniotomy and general anesthesia: a randomized-controlled trial Post-craniotomy pain is a common clinical issue and its optimal management remains incompletely studied. Utilization of a regional scalp block has the potential advantage of reducing perioperative pain and opioid consumption, thereby facilitating optimal postoperative neurologic assessment. The purpose (...) of this study was to assess the efficacy of regional scalp block on post-craniotomy pain and opioid consumption.We performed a prospective randomized-controlled trial in adults scheduled to undergo elective supratentorial craniotomy under general anesthesia to assess the efficacy of postoperative bilateral scalp block with 0.5% bupivacaine with 1:200,000 epinephrine compared with placebo on postoperative pain and opioid consumption. The primary outcome was the visual analogue scale (VAS) for pain at 24 hr
Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity (...) and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI
cord activation in response to therapy via recorded evoked compound action potentials (ECAPs) in patients during daily use. These ECAPs are also used to optimise programming and deliver closed-loop spinal cord stimulation by adjusting the stimulation current to maintain activation within patients' therapeutic window. We aimed to examine painrelief and the extent of spinal cord activation with ECAP-controlled closed-loop versus fixed-output, open-loop spinal cord stimulation for the treatment (...) patients; difference 22·0%, 6·3-37·7; p=0·0060). We observed no differences in safety profiles between the two groups. The most frequently reported study-related adverse events in both groups were lead migration (nine [7%] patients), implantable pulse generator pocket pain (five [4%]), and muscle spasm or cramp (three [2%]).ECAP-controlled closed-loop stimulation provided significantly greater and more clinically meaningful painrelief up to 12 months than open-loop spinal cord stimulation. Greater
and ketorolac in women who received intrathecal morphine and a multimodal analgesic regimen. Clinical trial registration: ClinicalTrials.gov, . Funding source: The study was supported in part by Avanos Medical Inc. Similar articles P O'Neill et al. Anesth Analg 114 (1), 179-85. Jan 2012. PMID 22025490. - Randomized Controlled Trial Continuous wound infusion with ropivacaine for 48 hours after cesarean delivery was associated with better analgesia, a lower incidence of side effects, less need for nur … O (...) Solovyova et al. J Bone Joint Surg Am 95 (21), 1935-41. 2013. PMID 24196463. - Randomized Controlled Trial Local infiltration analgesia alone or followed by continuous infusion of ropivacaine as part of multimodal analgesia provides no additional analgesic benefit or reduction … JP Kainu et al. Int J Obstet Anesth 21 (2), 119-24. Apr 2012. PMID 22341892. - Randomized Controlled Trial Compared to saline control, continuous wound infusion with ropivacaine failed to reduce the use of intravenous oxycodone
and heterogeneity was found. SUCRA scores showed that spinal analgesia was the best intervention for postoperative pain and opiate reduction at 24 h. Transversus abdominus plane blocks were effective in reducing pain and opiate consumption 24 h after surgery. Subgroup analysis showed similar results for open versus minimally invasive surgical approaches, and enhanced recovery after surgery programmes. Conclusion: Spinal analgesia and transversus abdominus plane blocks best balanced paincontrol and opiate (...) -Analysis of Local and Regional Analgesia Following Colorectal Resection W Xu et al. Br J Surg . Jan 2020 Show details Br J Surg Actions , 107 (2), e109-e122 Authors , , , , Affiliation 1 Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. PMID: 31903601 DOI: Item in Clipboard Full-text links Cite Abstract in , Background: Postoperative painmanagement after colorectal surgery remains challenging. Systemic opiates delivered
, A., Carrasco-Labra, A., and Mariotti, A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. JADA . 2018 ; 149 : 256–265 e3 | | | | | Localized acute apical abscess is characterized by spontaneous pain with or without mastication, percussion, or palpation, with formation of purulent material, localized swelling, and without evidence of fascial space or local lymph node involvement, fever, or malaise (fatigue, reduced (...) tablet less and 2 more rescue analgesic tablets than those who did not take antibiotics over 7 days (low certainty) ( eTable 3 , available online at the end of this article). x 40 Nagle, D., Reader, A., Beck, M., and Weaver, J. Effect of systemic penicillin on pain in untreated irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2000 ; 90 : 636–640 | | | | | We identified no randomized controlled trials meeting our selection criteria that reported undesirable effects
a sign of relief. But what nerve block? And will it work? You nod smartly in agreement and excuse yourself to the bathroom to check out some online resources… PICO Question Population: Elderly patients with acute hip fracture in the emergency department Intervention: Regional nerve block with any local anesthetic for analgesia (femoral nerve block, 3-in-1 nerve block, or fascia iliaca block) Comparison: Standard painmanagement strategy without regional nerve block Outcome: Pain scores during ED (...) Medicine, including Dr. Jason Snyder from Trauma Surgery. PGY-I This was the only systematic review evaluated. Meta-analysis was not performed due to differences in regional nerve block methods used and pain assessment techniques. Seven ED-based RCT’s of overall low quality demonstrate immediate and sustained painrelief with either single femoral nerve block or continuous catheter infused femoral nerve block. In addition, less rescue opioid analgesia is required. For now, the benefits appear
: Randomized Controlled Trial , , Affiliations Expand Affiliation 1 Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta 31527, Egypt. PMID: 31686901 PMCID: DOI: Item in Clipboard The Effect Of The Use Of Pre-Emptive Oral Pregabalin On The Postoperative Spinal Analgesia In Patients Presented For Orthopedic Surgeries: Randomized Controlled Trial Amany F Omara et al. J Pain Res . 2019 Show details J Pain Res Actions , 12, 2807-2814 Authors , , Affiliation 1 (...) consumption in the first 24 hours after double-jaw surgery. Multimodal analgesia techniques … U Bafna et al. J Anaesthesiol Clin Pharmacol 30 (3), 373-7. Jul 2014. PMID 25190946. We conclude that preemptive use of gabapentin 600mg and pregabalin 150 mg orally significantly reduces the postoperative rescue analgesic requirement and increases the du … T Kiatchai et al. J Anesth 31 (6), 861-868. Dec 2017. PMID 28918556. - Randomized Controlled Trial A single preoperative dose of pregabalin 150 mg did
Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane (...) ; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first painrelief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for paincontrol and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment.These
. This randomized controlled trial, following a pretest-posttest design, enrolled 127 patients with CBP (pain duration >12 weeks) from the Back Pain Center, Neurology, University Hospital Essen, Germany. Patients randomized to the open-label placebo group received a 3-week open-label placebo treatment. Patients in the treatment as usual (TAU) group received no intervention. Both groups continued TAU. Primary outcome was the change in pain intensity. Secondary outcomes included patient-reported functional (...) Effects of open-label placebo on pain, functional disability, and spine mobility in patients with chronic back pain: a randomized controlled trial Chronic back pain (CBP) is a major global health problem, while its treatment is hampered by a lack of efficacy and restricted safety profile of common frontline therapies. The present trial aims to determine whether a 3-week open-label placebo treatment reduces pain intensity and subjective and objective functional disability in patients with CBP
Intraoperative methadone administration and postoperative paincontrol: a systematic review and meta-analysis Postoperative pain is not adequately managed in greater than 40% of surgical patients and is a high priority for perioperative research. In this meta-analysis, we examined studies comparing postoperative opioid consumption and pain scores in surgical patients who received methadone by any route vs those who received another opioid by any route. Studies were identified from PubMed (...) control (mean difference = -15.22 mg oral morphine equivalents, 95% confidence interval -27.05 to -3.38; P = 0.01). Patients in the methadone group generally reported lower postoperative pain scores in 7 of 10 studies. Meta-analysis revealed greater satisfaction scores with analgesia in the methadone group vs control (0-100 visual analog scale; mean difference = 7.16, 95% confidence interval 2.30-12.01; P = 0.004). There was no difference in time-to-extubation, time-to-first analgesia request
The serratus plane block for postoperative analgesia in breast and thoracic surgery: a systematic review and meta-analysis The serratus plane block (SPB) is a novel chest wall interfascial plane block. Its analgesic efficacy compared with non-block care and paravertebral block (PVB) is unestablished.We conducted a random-effects meta-analysis of randomized controlled trials (RCTs) recruiting adult surgical patients that compared a SPB to non-block care or PVB for postoperative analgesia. Visual (...) analog scale pain scores were the primary outcome. Database sources were Medline, Embase, the Cochrane Library, and Google Scholar searched up to July 29, 2019 without language restriction. Risk of bias was assessed using Cochrane methodology.Nineteen RCTs that comprised 1260 patients were included. Six trials involved thoracic surgery patients and 13 studied breast surgery patients. SPB reduced pain scores 0 hour postoperatively (-1.62 cm; 99% CI -2.43 to -0.81; p<0.001; I2=92%), at 2-4 hours (-1.29
Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study Quadratus lumborum (QL) block is a new regional analgesic technique for upper and lower abdominal surgeries as part of a multimodal analgesic regime. It has also been reported to relieve pain after total hip arthroplasty (THA). In this prospective, randomized, double-blind study, we compared QL block with control (no block) in patients undergoing primary THA.Eighty patients undergoing primary (...) recorded.The study analysis included 36 patients in the QL group and 35 patients in the control group. Both VAS pain score at 24 hours (difference -1.76, 95% CI -2.87 to -0.64) and cumulative opioid consumption were significantly lower in the QL group at 12, 12-24, 24, 24-48, and 48 hours after surgery as compared with the control group (difference at 48 hours -36.13, 95% CI -62.89 to -9.37) (p<0.05). However, there was no difference in pain score at 12 and 48 hours, nor in the ambulation distance