Articles: opioid-analgesics.
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J Clin Monit Comput · Apr 2022
Pupillary unrest, opioid intensity, and the impact of environmental stimulation on respiratory depression.
Opioid-induced respiratory depression (OIRD) confers significant morbidity, but its onset can be challenging to recognize. Pain or stimulation effects of conversation may mask or attenuate common clinical manifestations of OIRD. We asked whether pupillary unrest could provide an objective signal of opioid exposure, and whether this signal would be independent from the confounding influence of extrinsic stimulation. ⋯ PUAL is a consistent indicator of opioid effect, and distinguishes higher opioid concentrations independently of the stimulating effects of conversational interaction. Under equivalent opioid exposure, conversational interaction delayed the onset and minimized the severity of OIRD. Clinical trial registration: NCT04301895.
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Minerva anestesiologica · Apr 2022
ReviewOpioid use, misuse, and abuse: a narrative review about interventions to reduce opioid consumption and related adverse events in the perioperative setting.
Opioids remain the most potent and predictable drug available for perioperative analgesia and moderate-to-severe cancer-related pain. However, their efficacy has been questioned in other clinical settings. ⋯ Thus, there has been a significant effort to develop strategies to curtail their unnecessary prescription. Here, we summarize the history, current trends, and new directions in perioperative opioid prescription in an unbiased manner.
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Observational Study
Post-discharge Opioid Consumption After Minimally Invasive and Open Colectomy: Does Operative Approach Matter?
To determine if patients consume less opioid after minimally invasive colectomy compared to open colectomy. ⋯ Patients undergoing minimally invasive and open colectomy consume similar amounts of opioid after discharge. The size of the postoperative prescription, patient age, and diagnosis are more important in determining opioid use. Understanding factors influencing postoperative opioid requirements may allow surgeons to better tailor prescriptions to patient needs.
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Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by GPs who are calling for a clear overview of effective opioid reduction strategies for primary care. ⋯ Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long-term opioid treatment. However, because of high risk of bias and small sample sizes, no firm conclusions can be made demonstrating the need for more high-quality research.