Articles: analgesia.
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Multicenter Study
High- versus low-dose ketamine for analgesia in older adults in the emergency department.
Ketamine is increasingly being utilized in the management of acute pain in the emergency department (ED), including for older adults, a population at increased risk of adverse effects from medications. We aimed to compare the safety and analgesic effects of high-dose (≥0.3mg/kg) to low-dose (<0.3mg/kg) intravenous (IV) ketamine among older ED patients. ⋯ High-dose and low-dose ketamine reduced pain scores in older adults. High-dose ketamine led to a greater reduction in pain scores, and there was no observed difference in adverse effects or the need for rescue analgesia. One-third needed discontinuation of ketamine in both groups.
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Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes. ⋯ The PECS I/SAP block may potentially reduce pain in patients having breast surgery for cancer by providing analgesia to the lateral and anterior chest wall. While this analysis showed a reduction in intraoperative opioid consumption, no significant postoperative benefit in either pain scores, opioid consumption, or length of stay was observed. This may be in part due to the PECS I/SAP block not providing adequate analgesia to the medial portion of the breast.
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An increased interest has been observed in the wide use of intravenous patient-controlled analgesia (IV-PCA) to control acute postoperative pain in both China and Thailand. The safety and efficacy of IV-PCA in patient care requires competent and capable staff nurses. This study aimed to appraise the capabilities of Thai and Chinese registered nurses regarding IV-PCA as a guide to develop educational programs. ⋯ The study results call for intensive and effective training and education concerning all domains for registered nurses involved with patients receiving IV-PCA.
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Vaso-occlusive crisis causing severe pain can be seen in patients with sickle cell anemia and potent opioids should be used in this process. Although sickle cell disease (SCD) patients use patient-controlled analgesia (PCA), we encountered no study evaluating this method from the participants' perspective. ⋯ We found that PCA was used more correctly by participants with more experience using the device. Participants who delay demand dosing do so because of anxiety about developing dependence and to avoid high doses.