Articles: analgesics.
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Opioids are the most prescribed drugs for the alleviation of pain. Both clinical and preclinical studies have reported strong evidence for sex-related divergence regarding opioid analgesia. ⋯ This review presents an overview of the importance of gonadal steroids in modulating opioid analgesic responsiveness and focuses on elaborating what is currently known regarding the underlyingmechanism. We sought to identify the link between gonadal hormones and the effect of oipiod antinociception.
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Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity. ⋯ CRD42023399373 (PROSPERO).
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Both superficial and deep serratus anterior plane (SAP) blocks are effective for anterior chest wall surgeries, but there is little clarity on which is more effective. Hence, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the comparative efficacy of the 2 approaches for SAP block after anterior chest wall surgery. ⋯ Current evidence does not support the preference for one approach of SAP block over the other for postoperative pain. Based on the available data, we recommend further future trials to determine any differences between these interventions.
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Review Meta Analysis
Efficacy and safety of neuraxial hydromorphone: A systematic review and meta-analysis with trial sequential analysis.
Neuraxial hydromorphone provides postoperative pain relief. However, the magnitude of this effect and the optimal dose remain unknown. The objective of this study is to clarify these uncertainties. ⋯ If neuraxial hydromorphone is to be used regularly, trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space. More trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.
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Acute pain management is a critical component of prehospital and emergency medical care. Opioids are effective; however, the risks and side-effects of opioids have led providers to use low-dose ketamine (LDK) for safe and effective treatment of acute pain. ⋯ LDK is a safe and effective option for acute pain treatment. It can be used as an alternative therapy to opioids or used in conjunction with them to reduce opioid exposure through its opioid-sparing effect. Importantly, LDK is available in a variety of formulations including intramuscular, intravenous, and intranasal, making it an effective acute pain treatment option in both the prehospital and ED settings. LDK holds promise as an emergency treatment in the evolving landscape of acute pain management.