Articles: analgesics.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Predictors of Postoperative Morphine Milligram Equivalents in Cardiac Surgery.
Given both the short- and long-term deleterious effects of opioids, there has been an increased focused on reducing the use of postoperative opioid analgesia. As patients undergoing cardiac surgery often require high levels opioids postoperatively, understanding risk factors for increased postoperative opioid use may be helpful for the development of patient-specific opioid-sparing pain regimens for this patient population. ⋯ CABG, liver disease, patient-controlled analgesia, younger age, and higher BMI are associated with increased narcotic use after cardiac surgery. Implementation of more aggressive perioperative multimodal opioid-sparing regimens should be considered for these patient groups.
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American family physician · Dec 2024
Opioid Prescribing Has Significantly Decreased in Primary Care.
Prescription opioids continue to be commonly used for chronic non-cancer pain, despite inherent risks. Primary care physicians and advanced practice clinicians have been integral to driving change in opioid prescribing, preventing overuse, and reducing risk. The authors of this article assessed the current extent of opioid prescribing using publicly available data to identify which specialties are most likely to prescribe opioids and to what extent.
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Chronic opioid use (COU) after traumatic injuries is a global health concern. COU after trauma delays recovery and increases the risk of long-term drug dependence. However, the population-prevalence and factors associated with COU after traumatic injury in South Korea remain unclear. ⋯ Risk factors included being aged 65 to 74 years (aOR = 2.87; 95% CI = 2.73 to 3.01), aged ≥ 75 years (aOR = 2.48; 95% CI = 2.35 to 2.62), and history of previous opioid use (aOR = 3.27; 95% CI = 3.21 to 3.34) were the most significant risk factors of COU, independent of injury. COU was prevalent both in the injured and noninjured patients, with slightly increased risk of COU in those sustaining traumatic injury compared to those who were noninjured. Further stud y to address prevalent COU in South Korea is required to avoid opioid-related harms.
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Optimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. ⋯ Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors provide significant analgesic and opioid-sparing benefits. However, these analgesics are commonly avoided owing to concerns of potential adverse effects. The evidence for NSAID-related adverse effects is conflicting and of poor quality, and these analgesics are safer than what has been implied. Thus, it is imperative that NSAIDs or COX-2-specific inhibitors are administered routinely unless there are well-founded contraindications.