Current opinion in anaesthesiology
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Cesarean section is the most common surgical procedure performed in the world. Postoperative pain management remains a challenge, particularly in a context of enhanced recovery after surgery. Several barriers related to the specific condition of 'postpartum recovery' may prevent application of effective analgesia in this population. The present review focuses on novel approaches of cesarean section postoperative pain assessment, beyond pain-rating intensity, including objective patient-centered recovery parameters. Predictive tools currently available to target patients at high risk of acute and chronic pain are also examined. ⋯ Patient and healthcare provider education on reported pain and well tolerated analgesic use is the key to improve postpartum pain management after cesarean section.
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Curr Opin Anaesthesiol · Jun 2018
ReviewNeuraxial labor analgesia: a focused narrative review of the 2017 literature.
Neuraxial labor analgesia remains the most effective and one of the most commonly utilized methods for pain relief during labor. This narrative review article is a summary of the literature published in 2017 on neuraxial analgesia for labor. ⋯ Recent advances, as well as refinements, of current neuraxial analgesia techniques could improve women's experience of labor.
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Curr Opin Anaesthesiol · Jun 2018
ReviewIntraoperative blood pressure levels in young and anaesthetised children: are we getting any closer to the truth?
Blood pressure is a basic feature of monitoring during anaesthesia. However, it is very unclear what blood pressures are normal during anaesthesia in children. Furthermore, the clinical consequences of low blood pressure are also uncertain. Similarly, it is unclear when to initiate therapy for hypotension during anaesthesia. This review summarizes the most recent development on the interpretation of blood pressure measurements in children and the relation of low blood pressure to clinical outcome. ⋯ The recently published reference tables can guide anaesthesiologist in daily practice to define intraoperative hypotension. However, there are situations in which a higher blood pressure is recommendable and an individual approach is required.
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High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population. ⋯ Multimodal analgesia had demonstrated advantages for all types of gynecological surgeries in terms of improving postoperative pain control and minimizing opioid-related adverse effects. Multimodal analgesia includes acetaminophen, NSAIDS, and gamma-aminobutyric acid analogs combined with intraoperative nonopioid analgesics such as ketamine, regional anesthesia or intrathecal morphine. Further research should focus on determining most effective combinations and doses of multimodal analgesia.
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Curr Opin Anaesthesiol · Jun 2018
ReviewIs spinal anaesthesia in young infants really safer and better than general anaesthesia?
Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. ⋯ Spinal anaesthesia represents a suitable alternative to general anaesthesia in neonates and infants undergoing minor surgery avoiding the need for endotracheal intubation and ventilation. Spinal anaesthesia has some advantages but a significant failure rat and has not been demonstrated to improve neurodevelopmental outcome.