Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudyMultimodal analgesia to prevent propofol-induced pain: pretreatment with remifentanil and lidocaine versus remifentanil or lidocaine alone.
Propofol is well-known for its pain on injection. Premixture with lidocaine or pretreatment with remifentanil reduces injection pain. A multimodal approach might offer additional mitigation of propofol injection pain. ⋯ The combination of two different analgesic modalities, remifentanil and lidocaine completely abolishes moderate and severe pain associated with propofol injection, and significantly reduces the incidence of mild pain when compared with each drug used alone.
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudyThe influence of neck flexion and extension on the distribution of contrast medium in the high thoracic epidural space.
For safe and effective thoracic epidural analgesia (TEA), it is important to control the level of TEA and to identify factors that influence its spread. In this study, we observed the distribution of contrast injected into the high thoracic epidural space during neck flexion and extension. ⋯ Cranial spread of contrast in the high thoracic epidural space is limited. However, neck flexion increases cranial spread. These results suggest that when TEA is high, the tip of the epidural catheter should be located at the upper part of the level to be blocked and that neck flexion may cause an unwanted cervical block.
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Anesthesia and analgesia · Jun 2007
ReviewMagnesium as an adjuvant to postoperative analgesia: a systematic review of randomized trials.
Randomized trials have reached different conclusions as to whether magnesium is a useful adjuvant to postoperative analgesia. ⋯ These trials do not provide convincing evidence that perioperative magnesium may have favorable effects on postoperative pain intensity and analgesic requirements. Perioperative magnesium supplementation prevents postoperative hypomagnesemia and decreases the incidence of postoperative shivering. It may be worthwhile to further study the role of magnesium as a supplement to postoperative analgesia, since this relatively harmless molecule is inexpensive, and the biological basis for its potential antinociceptive effect is promising.
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Anesthesia and analgesia · Jun 2007
Review Comparative StudyDo surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety.
Gabapentin and pregabalin have antiallodynic and antihyperalgesic properties useful for treating neuropathic pain. These properties may also be beneficial in acute postoperative pain. In this study we evaluated randomized, controlled trials examining the analgesic efficacy, adverse effects, and clinical value of gabapentinoids in postoperative pain. ⋯ Gabapentinoids effectively reduce postoperative pain, opioid consumption, and opioid-related adverse effects after surgery. Conclusions about the optimal dose and duration of the treatment cannot be made because of the heterogeneity of the trials. Studies are needed to determine the long-term benefits, if any, of perioperative gabapentinoids.