Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2014
ReviewProcedure-specific pain management and outcome strategies.
Optimal dynamic pain relief is a prerequisite for optimizing post-operative recovery and reducing morbidity and convalescence. Procedure-specific pain management initiative aims to overcome the limitations of conventional guidelines and provide health-care professionals with practical recommendations formulated in a way that facilitates clinical decision making across all the stages of the perioperative period. ⋯ There is emphasis on the use of multimodal analgesia and preventive analgesia aimed at reducing central sensitization. Importantly, the benefits of dynamic pain relief may only be realized if other aspects of perioperative care such as the use of minimally invasive surgery, approaches to reduce stress responses, optimizing fluid therapy and optimizing post-operative nursing care with early mobilization and oral feeding are utilized.
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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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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
ReviewPerioperative analgesia and the effects of dietary supplements.
With over 50,000 dietary supplements available, resurgence in consumer interest over the past few decades has resulted in an explosion of use of these agents worldwide. Disillusionment with current medications and belief in "natural medicines" has resulted in a multibillion dollar industry. Active ingredients in a number of herbs are being tested for therapeutic potential, and some are efficacious, so herbal medicines cannot be dismissed. ⋯ The prudent anesthesia provider will make sure to obtain correct information as to accurate herbal usage of each patient and attempt to discontinue these products two to three weeks prior to the delivery of an anesthetic. Postoperative analgesia, bleeding, and level of sedation can be negatively impacted related to herbal products and herbal-drug interactions. Over 90 herbal products are associated with bleeding and this can be a specific problem intraoperatively or when considering placement of a regional anesthetic for postoperative pain management.