Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2012
Review Meta AnalysisThe prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis.
Many clinical trials have demonstrated the effectiveness of gabapentin and pregabalin administration in the perioperative period as an adjunct to reduce acute postoperative pain. However, very few clinical trials have examined the use of gabapentin and pregabalin for the prevention of chronic postsurgical pain (CPSP). We (1) systematically reviewed the published literature pertaining to the prevention of CPSP (≥ 2 months after surgery) after perioperative administration of gabapentin and pregabalin and (2) performed a meta-analysis using studies that report sufficient data. A search of electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, IPA, and CINAHL) for relevant English-language trials to June 2011 was conducted. ⋯ The present review supports the view that perioperative administration of gabapentin and pregabalin are effective in reducing the incidence of CPSP. Better-designed and appropriately powered clinical trials are needed to confirm these early findings.
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Anesthesia and analgesia · Aug 2012
Prior lumbar discectomy surgery does not alter the efficacy of neuraxial labor analgesia.
Lumbar discectomy surgery is a common neurosurgical procedure. Neuraxial labor analgesia may be less effective in parturients with a history of discectomy surgery because of postsurgical scarring and anatomical distortion. In this prospective observational case-controlled study, we compared bupivacaine consumption per hour of labor analgesia as an indirect measure of labor analgesic effectiveness between women with prior discectomy surgery and those who did not have back surgery. ⋯ There was no difference in hourly bupivacaine consumption in parturients with prior lumbar discectomy surgery undergoing neuraxial labor analgesia in comparison with controls. Time to placement of the epidural catheter was not different either, but more interspaces were attempted in the discectomy group. Our findings suggest that standard clinical neuraxial analgesic methods are effective in women with discectomy surgery.
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Anesthesia and analgesia · Aug 2012
Randomized Controlled TrialSystemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.
Intraoperative intravenous lidocaine improves the quality of recovery following ambulatory laparoscopic surgery.
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Anesthesia and analgesia · Aug 2012
Randomized Controlled Trial Comparative StudyPostoperative analgesic and behavioral effects of intranasal fentanyl, intravenous morphine, and intramuscular morphine in pediatric patients undergoing bilateral myringotomy and placement of ventilating tubes.
Bilateral myringotomy and placement of ventilating tubes (BMT) is one of the most common pediatric surgical procedures in the United States. Many children who undergo BMT develop behavioral changes in the postanesthesia care unit (PACU) and require rescue pain medication. The incidence of these changes is lower in children receiving intraoperative opioids by the nasal, IM, or IV route compared with placebo. However, there are no data to indicate which route of administration is better. Our study was designed to compare the immediate postoperative analgesic and behavioral effects of 3 frequently used intraoperative techniques of postoperative pain control for patients undergoing BMT under general anesthesia. ⋯ In this double-blind, double-dummy study, there was no difference in the efficacy of intranasal fentanyl, IM and IV morphine in controlling postoperative pain and emergence delirium in children undergoing BMT placement. The IM route is the simplest and avoids the potential for delays to establish vascular access for IV therapy and the risks of laryngospasm if intranasal drugs pass through the posterior nasopharynx and irritate the vocal cords.
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Anesthesia and analgesia · Aug 2012
Randomized Controlled Trial WebcastsA placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part II. Population pharmacokinetic and pharmacodynamic modeling and simulation.
A new benzodiazepine, remimazolam, which is rapidly metabolized by tissue esterases to an inactive metabolite, has been developed to permit a fast onset, a short, predictable duration of sedative action, and a more rapid recovery profile than currently available drugs. We report on modeling of the data and simulations of dosage regimens for future study. ⋯ Population pharmacokinetic and pharmacodynamic models developed for remimazolam and midazolam fitted the observed data well. Simulations based on these models show that remimazolam delivers extremely rapid sedation, with maximal effect being reached within 3 minutes of the start of treatment. This property will enable maintenance doses to be given more accurately than with slower-acting drugs. No covariate effects considered to be clinically relevant were observed, suggesting that dosing by body weight may offer no advantage over fixed doses in terms of consistency of exposure to remimazolam within the weight range studied (65-90 kg).