European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
The effect of triple vs. double nonopioid therapy on postoperative pain and functional outcome after abdominal hysterectomy: A randomised double-blind control trial.
Movement-evoked pain is more severe than pain at rest and is likely to interfere more with functional recovery after surgery. ⋯ This trial failed to demonstrate substantial benefits with the addition of a third nonopioid analgesic to three different double-drug regimens. Further research is needed that will more definitively support expanding multimodal analgesic practices. Our results demonstrate consistent correlations between evoked pain and functional outcomes further emphasising the need for improved analgesic regimens that will accelerate postsurgical functional recovery.
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Observational Study
Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study.
Chronic pain and opioid consumption may trigger diffuse hyperalgesia, but their relative contributions to pain vulnerability remain unclear. ⋯ Chronic pain patients treated with low doses of opioid had hyperalgesia before surgery. These results highlight the need to personalise the management of patients treated with opioids before surgery.
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Comparative Study
Hyperalgesia and increased sevoflurane minimum alveolar concentration induced by opioids in the rat: A randomised experimental study.
Perioperative opioids reduce inhalational anaesthetic requirements. The initial hypoalgesia may, however, be followed by a rebound hyperalgesia. ⋯ Opioid-induced hyperalgesia was associated with an increase in the MAC in normal rats who had not undergone surgery. Both effects lasted 21 days and were prevented by ketamine.
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The antidepressant amitriptyline, the inhibitor of microglia activation minocycline, and the neurokinin-1 antagonist maropitant have all been used to prevent or treat hyperalgesia and opioid tolerance. ⋯ Amitriptyline, minocycline and maropitant reduced the minimum alveolar concentration and potentiated the remifentanil minimum alveolar concentration reduction but failed to block opioid-induced hyperalgesia and acute opioid tolerance.