Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2007
ReviewPROSPECT: evidence-based, procedure-specific postoperative pain management.
Existing general guidelines for perioperative pain management do not consider procedure-specific differences in analgesic efficacy or applicability of a given analgesic technique. For the clinician, an evidence-based, procedure-specific guideline for perioperative pain management is therefore desirable. This chapter reviews the methodology and results of ⋯ a public web site (www.postoppain.org) which provides information and recommendations for evidence-based procedure-specific postoperative pain management.
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Best Pract Res Clin Anaesthesiol · Mar 2007
ReviewUpdate on the role of non-opioids for postoperative pain treatment.
Non-opioids play an ever increasing role in the treatment of postoperative pain; either on their own for mild to moderate pain or in combination with other analgesic approaches, in particular opioids, as a component of multimodal analgesia. The analgesics paracetamol (acetaminophen) and dipyrone (metamizole) as well as compounds with an additional anti-inflammatory effect (non-selective non-steroidal anti-inflammatory drugs and selective cyclo-oxygenase-2 inhibitors) are used widely in the perioperative period. ⋯ Dipyrone continues to be used in many countries despite the ongoing debate on the incidence and relevance of its ability to cause agranulocytosis. Among the anti-inflammatory drugs, selective cyclo-oxygenase-2 inhibitors have the most supportive data for their beneficial effects as a component of multimodal analgesia and offer benefits with regard to their adverse effect profile.
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Best Pract Res Clin Anaesthesiol · Mar 2007
ReviewDo we need preemptive analgesia for the treatment of postoperative pain?
Preemptive analgesia means that an analgesic intervention is started before the noxious stimulus arises in order to block peripheral and central nociception. This afferent blockade of nociceptive impulses is maintained throughout the intra-operative and post-operative period. ⋯ So far, the promising results from animal models have not been translated into clinical practice. Therefore, clinicians should rely on conventional anaesthetic and analgesic methods with proven efficacy, i.e. a multimodal approach including the combination of strong opioids, non-opioid analgesics, and peripheral or neuraxial local anaesthetics that act at different sites of the pain pathways.
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Best Pract Res Clin Anaesthesiol · Mar 2007
ReviewThe clinical role of NMDA receptor antagonists for the treatment of postoperative pain.
Recent advances in the understanding of postoperative pain have demonstrated its association with sensitization of the central nervous system (CNS) which clinically elicits pain hypersensitivity. N-methyl-D-aspartate (NMDA) receptors play a major role in synaptic plasticity and are specifically implicated in CNS facilitation of pain processing. ⋯ However, the mechanisms underlying ketamine anti-hyperalgesic effect are not totally understood, and neither is the relationship between central sensitization and the risk of developing residual pain after surgery. This chapter examines the role of low doses of ketamine as an adjuvant drug in current perioperative pain management and questions the anti-hyperalgesic mechanisms involved.
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Best Pract Res Clin Anaesthesiol · Mar 2007
ReviewPostoperative pain treatment for ambulatory surgery.
One of the most significant changes in surgical practice during the last two decades has been the growth of ambulatory surgery. Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery. Recent studies have shown that large numbers of patients suffer from moderate to severe pain during the first 24-48 hr. ⋯ However, in the ambulatory setting many patients suffer from pain at home in spite of multimodal analgesic regimens. Sending patients home with perineural, incisional, and intra-articular catheters is a new and evolving area of postoperative pain management. Current evidence suggests that these techniques are effective, feasible and safe in the home environment if appropriate patient selection routines and organization for follow-up are in place.