Current opinion in anaesthesiology
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This article summarizes recent data related to the safety and efficacy of postoperative analgesia in children that influence clinical practice recommendations. ⋯ Recommendations for postoperative pain in children continue to evolve, with data incorporated from randomized controlled trials, case series and large audits. Management of pain following surgery in children needs to not only encompass efficacy and safety in the immediate perioperative period, but also consider pain following discharge after ambulatory surgery and the potential risk of persistent postsurgical pain following major surgery.
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Curr Opin Anaesthesiol · Oct 2015
ReviewAcute pain assessment tools: let us move beyond simple pain ratings.
This review highlights challenges and current trends in tools used to assess acute pain across the lifespan. ⋯ Valid and pragmatic assessment of pain is essential for effective pain management. Unidimensional scales that capture self-reported pain intensity ratings undervalue to the complexity of the pain experience. Pain is a biopsychosocial experience and assessment is a complex social transaction and an exchange of the meaning of pain that demands a more comprehensive approach.
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This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain surgery and in patients with acute stroke. ⋯ Recent evidence provides insufficient evidence of neuroprotective strategies to guide clinical management, and more randomized clinical trials are needed to optimize patient care.
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Awake craniotomy patients are exposed to various stressful stimuli while their attention and vigilance is important for the success of the surgery. We describe several recent findings on the perception of awake craniotomy patients and address nonpharmacological perioperative factors that enhance the experience of awake craniotomy patients. These factors could also be applicable to other surgical patients. ⋯ Preoperative preparation is of utmost importance in awake craniotomy patients, and a solid doctor-patient relationship is an important condition. Nonpharmacological intraoperative management should focus on reduction of fear and pain by adaptation of the environment and careful and well considered communication.
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This review outlines the analgesic role of perineural adjuvants for local anesthetic nerve block injections, and evaluates current knowledge regarding whether adjuvants modulate the neurocytologic properties of local anesthetics. ⋯ Dexmedetomidine added as a peripheral nerve blockade adjuvant improves block duration without neurotoxic properties. The combined adjuvants clonidine, buprenorphine, and dexamethasone do not appear to alter local anesthetic neurotoxicity. Midazolam significantly increases local anesthetic neurotoxicity in vitro, but when combined with clonidine-buprenorphine-dexamethasone (sans local anesthetic) produces no in-vitro or in-vivo neurotoxicity. Further larger-species animal testing and human trials will be required to reinforce the clinical applicability of these findings.