Articles: opioid-analgesics.
-
Best Pract Res Clin Anaesthesiol · May 2022
ReviewEnhancing recovery after cesarean delivery - A narrative review.
Enhanced recovery after cesarean delivery (ERAC) is increasingly being implemented worldwide with the aim to improve patient care for women undergoing this procedure. ERAC is associated with superior maternal outcomes including decreased length of hospital stay, opioid consumption, pain scores, times to mobilization and urinary catheter removal and hospitalization costs, without increasing hospital readmission rates. A number of preoperative, intraoperative, and postoperative interventions have been incorporated into ERAC protocols. ⋯ Protocols rarely assess patient-reported outcome measures, patient satisfaction, or patient experience. The best measures of ERAC success are yet to be fully elucidated. Further work is required to evaluate protocols, interventions, and how best to measure the effect of ERAC.
-
Int J Obstet Anesth · May 2022
Incidence of persistent postpartum opioid use by mode of delivery: a 2016 cohort study of Danish women.
The use of oral opioids as standard treatment after cesarean delivery has been linked to persistent use in opioid-naïve women in the USA. In Denmark, the use of opioids after cesarean delivery is typically restricted to in-hospital use. The aim of this study was to estimate the incidence of persistent postpartum opioid use in Denmark and compare the incidence by mode of delivery. ⋯ Women giving birth in Denmark, where use of post-discharge opioid treatment is generally restricted, have a low risk of developing persistent use of opioids, with very few women seeking additional analgesic treatment from their general practitioner.
-
Concomitant use of pregabalin with opioids and/or benzodiazepines is common, despite the increased risks. However, clinical trials suggest pregabalin can have an opioid-sparing effect when treating acute postoperative pain. We explored how opioid and benzodiazepine use changed over time in people initiating pregabalin, using dispensing claims data for a 10% sample of Australians (2013-19). ⋯ Among people using both opioids and pregabalin, the geometric mean daily dose in oral morphine equivalents increased after pregabalin initiation in all trajectories, ranging from +5.9% (99% confidence interval 4.8%-7.0%) to +39.8% (99% confidence interval 38.3%-41.5%) in people on the highest daily pregabalin dose. Among people using both pregabalin and benzodiazepines, the dose remained constant over time for people in all trajectories. Notwithstanding its reputation as opioid-sparing, in this outpatient setting, we observed that people using opioids tended to use higher opioid daily doses after pregabalin initiation, especially those on high pregabalin doses.
-
To quantify temporal changes in colonoscopy indication and assess appropriateness of surveillance use in older adults. ⋯ Guidelines should make clear recommendations about when and how to discontinue postpolypectomy surveillance colonoscopy. Doing so would potentially reduce harms due to complications from low-value procedures and in turn moderate demand and thereby enhance overall procedural access for patients more likely to benefit.
-
Palliative medicine · May 2022
ReviewEvidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review.
Patients with chronic obstructive pulmonary disease (COPD) face limited treatment options and inadequate access to palliative care. ⋯ Recommended interventions by guidelines are not always supported by high-quality evidence. Further research is required on efficacy and safety of inhaled corticosteroids, antidepressants, benzodiazepines, mucolytics, relaxation and breathing exercises.