Articles: analgesics.
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Acta Anaesthesiol Scand · Oct 2023
Generalizability of nociception level as a measure of intraoperative nociceptive stimulation: A retrospective analysis.
Nociception-guided intraoperative opioid administration might help reduce postoperative pain. A commonly used and validated nociception monitor system is nociception level (NOL), which provides the nociception index, ranging from 0 to 100, with 0 representing no nociception and 100 representing extreme nociception. We tested the hypothesis that NOL responses are similar in men and women given remifentanil and fentanyl, across various types of anesthesia, as a function of American Society of Anesthesiologists physical status designations, and over a range of ages and body morphologies. ⋯ Nociception level appears to provide accurate estimates of intraoperative nociception over a broad range of patients and anesthetic conditions.
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Preoperative assessment of pain fear could provide essential information for improving perioperative care and could be the first step toward targeted pain management. ⋯ In this research, findings demonstrated that as the patients' pain fear increased, postoperative pain severity and amount of analgesia increased. Providing pain management with analgesics increases comfort in patients, but it may cause secondary problems in patients who use high-dose analgesics. Therefore, reducing pain fear, which is one of the main factors in pain, is essential in pain management.
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Palliative medicine · Oct 2023
Review Meta AnalysisEffectiveness and safety of opioids on breathlessness and exercise endurance in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomised controlled trials.
Opioids are recommended to treat advanced refractory dyspnoea despite optimal therapy by the American Thoracic Society clinical practice guidelines, while newly published randomised controlled trials of opioids in chronic obstructive pulmonary disease yield conflicting results. ⋯ Sustained-release opioids did not improve dyspnoea and exercise endurance. Short-acting opioids appeared to be safe, have potential to lessen dyspnoea and improve exercise endurance, supporting benefit in managing episodes of breathlessness and providing prophylactic treatment for exertional dyspnoea.
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Randomized Controlled Trial
Intraoperative Methadone in Next-day Discharge Outpatient Surgery: A Randomized, Double-Blinded, Dose-Finding Pilot Study.
Contemporary perioperative practice seeks to use less intraoperative opioid, diminish postoperative pain and opioid use, and enable less postdischarge opioid prescribing. For inpatient surgery, anesthesia with intraoperative methadone, compared with short-duration opioids, results in less pain, less postoperative opioid use, and greater patient satisfaction. This pilot investigation aimed to determine single-dose intraoperative methadone feasibility for next-day discharge outpatient surgery, determine an optimally analgesic and well-tolerated dose, and explore whether methadone would result in less postoperative opioid use compared with conventional short-duration opioids. ⋯ The most effective and well-tolerated single intraoperative induction dose of methadone for next-day discharge surgery was 0.25 mg/kg ideal body weight (median, 14 mg). Single-dose intraoperative methadone was analgesic and opioid-sparing in next-day discharge outpatient surgery.