Best practice & research. Clinical anaesthesiology
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The treatment of cancer pain is paramount to both medical practitioner and patient in order to maximize quality of life. Cancer pain results from direct tumor effects as well as from surgical and medical treatments. Despite therapeutic advancements, morbidity and mortality in cancer care remains high, often from local recurrence or metastasis. ⋯ Opioids have been shown to cause immunosuppression and stimulate malignant cells in vitro, though adjunct analgesics may additionally promote tumor cell growth. These results have led many to hypothesize that regional analgesic techniques may offer survival advantages to systemic analgesics. Thus far, the data do not support specific analgesic recommendations for the cancer patient, though ongoing prospective, randomized clinical trials are under way to better characterize the safest analgesic regimens for cancer patients.
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Best Pract Res Clin Anaesthesiol · Jun 2014
ReviewGenetics and implications in perioperative analgesia.
The wide range of patient responses to surgical pain, opioids, and anesthetic agents has puzzled anesthesiologists for many years. Much of the variation has been attributed to differences in patient size, technique, or prior drug use. However, recent genetic testing has revealed exciting clues into the basis for these variances, allowing us to start to predict which patients may have difficulties and start to select medications more rationally. In this manuscript, we discuss genetics and pain perception, genetic predisposition to pain, drug metabolism interactions, ethnogenetics, opioid metabolism, opioid receptors, genetic-related peri-anesthetic toxicity, as well as a clinical approach and a discussion regarding the future of genetic testing and anesthesia.
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Best Pract Res Clin Anaesthesiol · Jun 2014
ReviewPsychiatric agents and implications for perioperative analgesia.
The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. ⋯ This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.
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Despite an appreciation for many unwanted physiological effects from inadequate pain postoperative relief, moderate to severe postoperative pain remains commonplace. Though treatment options have evolved in recent years, including improvement in medications, multimodal regimens, and regional anesthetic techniques, including ultrasound and continuous catheters, outcomes data indicate that many of these strategies are associated with varying degrees of morbidity and mortality. This review focuses on the importance of effective postoperative analgesia and both short- and long-term effects associated with inadequate management. A careful literature review of emphasizing treatment options and potential pathogenesis associated with these strategies is emphasized in this review.
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Best Pract Res Clin Anaesthesiol · Jun 2014
ReviewSupraclavicular and paravertebral blocks: Are we underutilizing these regional techniques in perioperative analgesia?
There has been a renewed interest in supraclavicular and paravertebral blocks for regional anesthesia. Studies have shown a high block success rate with the supraclavicular approach to the brachial plexus. Despite the use of ultrasound, pleural puncture and pneumothorax may still occur. ⋯ Paravertebral blocks have been used successfully to provide analgesia and anesthesia for a variety of surgical procedures. When compared to thoracic epidural blockade for thoracic surgery, paravertebral blockade provides comparable analgesia with a better preservation of pulmonary function and a lower incidence of hypotension. This brings forth the question as to whether paravertebral blocks have replaced epidural blockade as the gold standard in perioperative pain management for thoracoabdominal procedures.