Articles: analgesics.
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Multicenter Study Comparative Study
Comparative efficacy of intrathecal morphine and adductor canal block in the knee arthroplasty population: a retrospective multi-centre cohort study.
Finding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay. ⋯ The combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone.
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Voltage-gated sodium (Nav) channels present untapped therapeutic value for better and safer pain medications. The Nav1.8 channel isoform is of particular interest because of its location on peripheral pain fibers and demonstrated role in rodent preclinical pain and neurophysiological assays. To-date, no inhibitors of this channel have been approved as drugs for treating painful conditions in human, possibly because of challenges in developing a sufficiently selective drug-like molecule with necessary potency not only in human but also across preclinical species critical to the preclinical development path of drug discovery. ⋯ In this report, we have leveraged numerous physiological end points in nonhuman primates to evaluate the analgesic and pharmacodynamic activity of a novel, potent, and selective Nav1.8 inhibitor compound, MSD199. These pharmacodynamic biomarkers provide important confirmation of the in vivo impact of Nav1.8 inhibition on peripheral pain fibers in primates and have high translational potential to the clinical setting. These findings may thus greatly improve success of translational drug discovery efforts toward better and safer pain medications, as well as the understanding of primate biology of Nav1.8 inhibition broadly.
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Reg Anesth Pain Med · Oct 2024
Opioid tapering after surgery and its association with patient-reported outcomes and behavioral changes: a mixed-methods analysis.
Opioid tapering after surgery is recommended among patients with chronic opioid use, but it is unclear how this process affects their quality of life. The objective of this study was to evaluate how opioid tapering following surgery was associated with patient-reported outcome measures related to pain control and behavioral changes that affect quality of life. ⋯ Partial and complete opioid tapering within 90 days after surgery among patients with chronic opioid use was associated with improved patient-reported measures of pain control as well as behaviors that impact a patient's quality of life.
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Reg Anesth Pain Med · Oct 2024
ReviewMultiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder.
Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. ⋯ This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.