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2.
Arthroscopy ; 36(9): 2486-2487, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891249

RESUMO

Identification of risk factors for prolonged opioid use is imperative as opioid misuse continues to plague society. Recent data suggest that many modifiable and nonmodifiable patient factors may be associated with prolonged opioid use after arthroscopic meniscal surgery. Surgeons and patients share the burden of the opioid epidemic and must collaborate to decrease the overall opioid burden on society. As the number of tools to treat pain and the knowledge of at-risk patients grow, standardized postoperative narcotic regimens to treat a diverse population of patients are no longer acceptable; narcotic regimens must be customized to each patient. To limit opioid use and enhance patient outcomes, it is apparent that the next frontier of postoperative pain control is upon us: the personalization of pain control.


Assuntos
Analgesia , Osteoartrite do Joelho , Analgésicos Opioides , Artroscopia , Humanos , Masculino , Meniscectomia , Dor Pós-Operatória
4.
Adv Clin Exp Med ; 29(9): 1117-1121, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32937040

RESUMO

BACKGROUND: Patients treated in neonatal/pediatric intensive care units (N/PICUs) are frequently exposed to pain. To assess its severity, several behavioral and behavioral-physiological scales are used, but their usefulness is limited. It is therefore justified to search for additional methods to assess the adequacy of analgesia and sedation in these patients. OBJECTIVES: To evaluate the usefulness of skin conductance (SC) measurement in the assessment of analgosedation quality in infants requiring mechanical ventilation treated in N/PICUs. MATERIAL AND METHODS: Thirty infants aged 6-208 days treated in 6 N/PICUs, mechanically ventilated and receiving analgosedation, were included for the study. Simultaneous COMFORT-B assessment and SC measurement using SCA (skin conductance algesimeter) monitor were performed. Due to technical problems, not all of the SC records could be interpreted, and finally 412 simultaneous assessments on the COMFORT-B scale and SC measurements in 29 patients were analyzed. RESULTS: We found a statistically significant correlation between the COMFORT-B scoring and the SC measurements. Additionally, SC was significantly lower when the behavioral score indicated deep sedation, in comparison to periods when it indicated moderate or insufficient analgosedation. CONCLUSIONS: Skin conductance measurements are comparable with the COMFORT-B rating in mechanically ventilated infants receiving analgosedation. The SCA monitor may be of value in the assessment of analgosedation quality, and in particular may identify the situation where sedation is deep. Further research is needed regarding the suitability of this device in clinical practice.


Assuntos
Respiração Artificial , Analgesia , Criança , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Dor , Projetos Piloto
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(9): 923-930, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-32933620

RESUMO

Compared with adults, neonates tend to have stronger and more persistent biological perception of pain. They may have the memory for pain and the negative effects caused by pain may exist for a long time. Therefore, standardized pain management can reduce or prevent the adverse effect of pain on body and mind and promote the rehabilitation process. In order to further deepen the understanding of pain management and standardize the analgesic measures for neonates, the Neonatologist Branch of Chinese Medical Association and Editorial Board of Chinese Journal of Contemporary Pediatrics have developed an expert consensus based on the clinical evidence in China and overseas and with reference to clinical experience from the following aspects: evaluation of neonatal pain and methods and techniques of pain management. It is recommended to adopt a step-by-step analgesic management for neonates. For mild pain stimulation, it is effective to relieve the pain by gentle touch and non-nutritive sucking combined with sucrose feeding. For moderate pain, selection of appropriate trocar needle and skilled puncture are important to reduce the pain, and in addition, the application of local anesthetics at the site of puncture also has a good effect. For severe pain, intravenous sedative drugs are often required, but no consistent evidence has been obtained so far.


Assuntos
Analgesia , Dor , China , Consenso , Humanos , Recém-Nascido , Medição da Dor
6.
Medicine (Baltimore) ; 99(36): e21971, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899035

RESUMO

BACKGROUND: The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. METHODS: Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. RESULTS: We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). CONCLUSIONS: LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.


Assuntos
Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Morfina/administração & dosagem , Anestesia Local , Humanos , Injeções Espinhais , Tempo de Internação , Dor Pós-Operatória/prevenção & controle
7.
Medicine (Baltimore) ; 99(38): e22354, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957407

RESUMO

BACKGROUND: Childbirth is a complex and special physiological process. Pain often accompanies the whole process of delivery. Long term pain will affect the physiological and psychological of pregnant women, and severe pain will affect the delivery process and the life of maternal and fetal. There are 2 ways to relieve delivery pain: drug analgesia and nonpharmacological analgesia. Nonpharmacological analgesia has less effect on the fetus than drug analgesia and is currently a more popular method for labor analgesia. Due to the lack of randomized trials comparing the efficacy of various nonpharmacological analgesia, it is still difficult to judge the relative efficacy. Therefore, we intend to conduct a network meta-analysis to evaluate the benefit among these nonpharmacological analgesia. METHODS: According to the retrieval strategies, randomized controlled trials on nonpharmacological analgesia delivery will be obtained from China National Knowledge Infrastructure, WanFang,SinoMed, PubMed, Web of science, Embase, and Cochrane Library, regardless of publication date or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed in Markov Chain Monte Carlo method and carried out with Stata14 and OpenBUGS14 software. Ultimately, the evidentiary grade for the results will be evaluated. RESULTS: This study will provide more reasonable choice for clinic than the effect of nonpharmacological analgesia in parturient delivery. CONCLUSION: Our findings will provide references for future guidance developing and clinical decision.INPLASY registration number: INPLASY202080097.


Assuntos
Analgesia/métodos , Parto Obstétrico/efeitos adversos , Dor do Parto/terapia , Manejo da Dor/métodos , Feminino , Humanos , Metanálise em Rede , Gravidez , Revisões Sistemáticas como Assunto
8.
Curr Opin Anaesthesiol ; 33(5): 692-697, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826623

RESUMO

PURPOSE OF REVIEW: Thoracic myofascial plane blocks have gained popularity because of their ease of performance and relative safety. This review highlights current research demonstrating the efficacy of these blocks for specific surgical procedures and provides a brief description of how these techniques are performed. RECENT FINDINGS: Fascial plane blocks of the thorax and chest wall have been shown to be beneficial in providing perioperative analgesia for a variety of surgical procedures. Studies discussed in this review compare thoracic fascial plane blocks to systemic analgesia alone, contrast these novel methods of pain control to more traditional techniques, such as paravertebral nerve blocks and epidural anesthesia, and attempt to determine, which fascial plane blocks provide optimal postsurgical analgesia. SUMMARY: Thoracic fascial plane blocks provide the anesthesiologist a number of techniques to address postsurgical pain. The relative ease of performance and safety profile of these blocks make them an appealing option for pain control for many patients undergoing thoracic or chest wall surgery. Further research is needed to not only define additional indications for each of these blocks, but also explore optimal dosing including the use of continuous catheter techniques.


Assuntos
Analgesia/métodos , Bloqueio Nervoso/métodos , Manejo da Dor , Dor Pós-Operatória/prevenção & controle , Parede Torácica , Analgesia/tendências , Humanos , Bloqueio Nervoso/tendências , Dor
9.
Curr Opin Anaesthesiol ; 33(5): 633-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826629

RESUMO

PURPOSE OF REVIEW: Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years. RECENT FINDINGS: Multiple studies have examined the use of ketamine in a variety of environments, as ketamine has become more popular in emergency rooms and ICUs. Ketamine may be particularly beneficial in management of burn patients, who often require multiple procedures over the course of their treatment. Ketamine's role in the ongoing opioid crisis has been of particular interest, with multiple studies evaluating its potential role in managing both acute and chronic pain conditions. Ongoing studies examining the role of ketamine in treatment of depressions show promise as well. SUMMARY: Ketamine is regaining popularity in the field of anesthesia and beyond. New studies provide insight on the many indications and use that anesthesia providers may encounter during their perioperative care of patients. Ongoing research is needed to further elucidate ketamine's effects on the management of psychiatric conditions and potential indications for ketamine metabolites.


Assuntos
Analgesia , Analgésicos/farmacologia , Anestesia , Anestésicos Dissociativos/farmacologia , Queimaduras/tratamento farmacológico , Depressão/tratamento farmacológico , Ketamina/farmacologia , Dor/tratamento farmacológico , Humanos , Manejo da Dor , Período Perioperatório
10.
Wiad Lek ; 73(7): 1470-1475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32759439

RESUMO

OBJECTIVE: The aim: to compare the efficacy of pectoral nerve block type II and thoracic paravertebral block for analgesia during and after breast cancer surgery. PATIENTS AND METHODS: Materials and methods: Sixty adult women were undergoing unilateral radical mastectomy or quadrantectomy with axillary dissection. Patients were randomized to receive either pectoral nerve block with ropivacaine 0.375% 30 ml or thoracic paravertebral block with ropivacaine 0.5% 20 ml. Evaluated variables included pain intensity at 0, 2, 4, 6, 12, 18 and 24 hours, intraoperative fentanyl, 24-hour postoperative opioid (promedol) and nonopioid (ketoprofen) consumption, the time to first rescue analgesia. RESULTS: Results: There were no statistically significant differences between pectoral block and paravertebral block groups in intraoperative fentanyl consumption 2,2 (1,81-2,81) vs 1,9 (1,63-2,25) mcg/kg/hour (Р>0,05) and in the pain intensity during the first 24 hours after operation. The mean postoperative 24-hour promedol and ketoprofen consumption was 4,0 (±8,14) mgvs 5,0 (±8,85) mg (Р>0,05) and 66,7 (±66,09) mgvs 95,8 (±90,78) mg (Р>0,05) in the pectoral and paravertebral block groups respectively. Time to the first analgesia request was longer in pectoral block group - 540 (455,0-600,0) min vs 515 (265,0-650,0) min (Р>0,05). There were no complications after pectoral blocks and 2 complications after paravertebral blocks. CONCLUSION: Conclusions: in breast cancer surgery pectoral nerve blocktype II can provide postoperative analgesia comparable to thoracic paravertebral block with lower complications rate.


Assuntos
Analgesia , Neoplasias da Mama , Bloqueio Nervoso , Nervos Torácicos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Dor Pós-Operatória
11.
Anaesth Intensive Care ; 48(4): 306-313, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32819166

RESUMO

The aim of this prospective cohort study was to describe the anaesthetic practices, rates of postoperative pain and the recovery trajectory of children having urgent dental extractions at our institution. Demographic, anaesthetic and surgical details of children undergoing dental extractions were obtained by case note review. Parent-proxy pain scores were collected via telephone on the day of surgery and on postoperative days, as well as details of analgesia given, behavioural disturbance, and nausea and vomiting. Follow-up was continued until each child no longer had pain. Datasets were analysed for 143 patients. Fasting times were prolonged, with 81 children (56.6%) fasted for over four hours from fluids. Moderate or severe pain was recorded in 14 children (9.8%) postoperatively on the day of surgery, with higher rates in children who had a greater number of teeth extracted. Low rates of moderate to severe pain were observed during follow-up, affecting six children (4.2%) on postoperative day 1 and three children (2.1%) on postoperative day 2 with primarily simple analgesia administered at home. Only eight children (5.6%) had nausea and/or vomiting on the day of surgery. Rates of reported behavioural disturbance at home were low, extending beyond the second postoperative day in only two children (1.4%), and only four children (2.8%) attended a dentist during the follow-up period. In conclusion, the low rates of pain and nausea and vomiting reported in the days following surgery for urgent dental procedures suggest that children can be cared for at home with simple analgesia.


Assuntos
Analgesia , Anestesia , Dor Pós-Operatória , Extração Dentária , Criança , Humanos , Estudos Prospectivos
12.
Am Surg ; 86(8): 950-954, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762466

RESUMO

BACKGROUND: There is an opioid epidemic in the United States. With the increased concern of over-prescribing opioids, physicians are seeking alternative pain management strategies. The purpose of this study is to review the impact of instituting a multimodal analgesia (MMA) guideline on decreasing opioid use in trauma patients at a Level 1 trauma center. METHODS: In 2017, an MMA guideline was developed and included anti-inflammatories, muscle relaxants, neuropathic agents, and local analgesics in addition to opioids. Staff were educated and the guideline was implemented. A retrospective review of medications prescribed to patients admitted from 2016 through 2018 was performed. Patients admitted in 2016 served as the control group (before MMA). In 2018, all patients received multimodal pain therapy as standard practice, and served as the comparison group. RESULTS: A total of 10 340 patients were admitted to the trauma service from 2016 through 2018. There were 3013 and 3249 patients for review in 2016 and 2018, respectively. Total morphine milligram equivalents were 2 402 329 and 1 975 935 in 2016 and 2018, respectively, a 17.7% decrease (P < .001). Concurrently, there was a statistically significant increase in the use of multimodal pain medications. A secondary endpoint was studied to evaluate for changes in acute kidney injury; there was not a statistically significant increase (0.56% versus 0.68%, P = .55). DISCUSSION: Implementation of an MMA guideline significantly reduced opioid use in trauma patients. The use of nonopioid MMA medications increased without an increased incidence of acute kidney injury.


Assuntos
Analgesia/métodos , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/tendências , Prescrição Inadequada/prevenção & controle , Padrões de Prática Médica/tendências , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgesia/normas , Feminino , Humanos , Prescrição Inadequada/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
14.
Artigo em Alemão | MEDLINE | ID: mdl-32736388

RESUMO

The true incidence of infectious complications related to regional anaesthesia and analgesia is not known but like any invasive procedure is has the potential for severe sequelae. This article gives an overview on hygiene requirements based on the S1-guideline "Hygiene recommendations on regional anaesthesia", current recommendations of the Robert Koch-Institute and current scientific insights. Basic hygienic standards (removal of jewellery, accurate hand disinfection, clean environment) are to be applied. A face mask to cover nose and mouth, a surgical hair cap and sterile gloves are essential parts of any block. For catheter placements a sterile gown with long arms is recommended and also a sterile cover for the ultrasound probe (including the cable when catheters are placed). Skin disinfectant should be alcohol-based and contain a remanent ingredient (chlorhexidine or octenidine). Catheter tunneling may be protective when thoracic epidural catheters are used. When patient related factors (diabetes, obesity, immune suppression) and procedural factors (intended catheter use > 4 days, catheter site) are carefully weighed, an antibiotic prophylaxis may be taken into consideration.


Assuntos
Analgesia , Anestesia por Condução , Anestesia Epidural , Cateterismo , Humanos , Higiene
16.
17.
Medicine (Baltimore) ; 99(27): e20765, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629656

RESUMO

BACKGROUND: Remimazolam is a newly developed benzodiazepine as an alternative of conventional sedatives in the procedure of anesthesia. For the purpose of evaluating the efficacy and safety of remimazolam sedation during an endoscopy, we will perform a systematic review and meta-analysis of randomized controlled trials that compared remimazolam with midazolam and/or placebo. METHODS: We will search PubMed, Embase, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) from inception to December 2019 for randomized controlled trials that investigated efficacy and safety of remimazolam during an endoscopy. The job will be performed without language restriction. Experimental groups will include the interventions of remimazolam, while control groups will involve midazolam, placebo, or no controls. The primary outcome will be the onset time, followed by the secondary outcomes of the recovery time, the incidence of hypotension, the incidence of hypoxia and the incidence of bradycardia. Relative ratio or standardized mean difference will be used to measure the effect size of remimazolam. We will use I statistics to assess the between-study heterogeneity in each meta-analysis, Eager's test to detect publication bias. RESULTS: The results of this study will be published in a peer-reviewed journal. ETHICS AND DISSEMINATION: There is no need for ethical approval because all data used in this meta-analysis have been published. In addition, all data will be analyzed anonymously during the review process. PROTOCOL REGISTRATION NUMBER: CRD42020170745.


Assuntos
Analgesia/métodos , Benzodiazepinas , Sedação Consciente/métodos , Hipnóticos e Sedativos , Analgesia/efeitos adversos , Benzodiazepinas/efeitos adversos , Sedação Consciente/efeitos adversos , Humanos , Hipnóticos e Sedativos/efeitos adversos
18.
Medicine (Baltimore) ; 99(28): e20776, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664070

RESUMO

BACKGROUND: Femoral nerve block (FNB) is considered the preferred analgesia after anterior cruciate ligament reconstruction (ACLR), but leads to weakness in the quadriceps muscles. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. The purpose of our study was to compare the efficacy of FNB vs ACB for pain control after ACLR. METHODS: This prospective, randomized, double-blind, controlled, superiority clinical trial was approved by the institutional review board in our university hospital. We enrolled 120 patients set to undergo ACLR in this randomized therapeutic trial. Sixty patients received FNB and the other 60 received ACB for postoperative pain control. All ACB and FNB were performed using ultrasound-guided single-shot procedures. The primary outcomes included maximum voluntary isovolumetric contraction and postoperative pain score. Secondary outcomes included total opioid consumption, length of hospital stay, complication, and satisfaction score. RESULTS: This clinical trial might provide some insights to estimate and compare the safety and efficacy of ACB vs FNB following ACLR. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5569).


Assuntos
Analgesia/métodos , Reconstrução do Ligamento Cruzado Anterior , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Anestesia Geral , Nervo Femoral , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica
19.
Medicine (Baltimore) ; 99(28): e20968, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664101

RESUMO

BACKGROUND: The possibility of local infiltration analgesia (LIA) replacing interscalene blockade (ISB) as an integral component of a multimodal clinical pathway for total shoulder arthroplasty (TSA) needs to be further investigated. We thus further designed a randomized controlled study to compare LIA with ISB in the treatment of TSA. METHODS: This blinded and randomised study was performed after approval of the institutional review board in the first affiliated hospital of Jinan University. The included patients were all aged over 18 years and underwent shoulder arthroplasty because of osteoarthritis of the shoulder. Subjects were randomized into 2 groups as follows: LIA or ISB. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. Secondary outcomes included pain scores, length of hospital stay, complication, and satisfaction score. P value < .05 was considered statistically significant. RESULTS: For the present trial, we hypothesized that there would be no difference in pain score levels and opioid medication use throughout admission. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5640).


Assuntos
Analgesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Ombro , Bloqueio do Plexo Braquial , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Adulto , Método Duplo-Cego , Humanos , Lipossomos
20.
Curr Opin Anaesthesiol ; 33(4): 533-538, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628400

RESUMO

PURPOSE OF REVIEW: The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA. RECENT FINDINGS: Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, remifentanil, propofol, and ketamine. These traditional and well known drugs are commonly used for PSA. The combinational use of multiple drugs seems to have benefits for both the provider and patient. Furthermore, there is growing interest into specific protocols and adaption for special circumstances. The preferred medications used for PSA should be both effective and well tolerated. SUMMARY: Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient.


Assuntos
Analgesia/métodos , Anestesia/métodos , Hipnóticos e Sedativos/administração & dosagem , Sedação Consciente , Dexmedetomidina , Humanos , Ketamina , Salas Cirúrgicas , Propofol , Remifentanil
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