Articles: analgesia.
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Acta Anaesthesiol Scand · Mar 2024
Randomized Controlled TrialAn ultrasound-guided serratus anterior plane block with continuous local anaesthetic infusion and epidural analgesia for rib fracture pain.
We compared analgesia with an ultrasound (US)-guided serratus anterior plane block (SAPB) to thoracic epidural analgesia (EA) with continuous local anaesthetic infusion in patients with unilateral multiple traumatic rib fractures. EA often carries contraindications in patients with multiple rib fractures (MRFs), whereby having alternative effective methods to treat rib fracture pain remains important to patient care. Thus, we hypothesised that both regional anaesthetic techniques would provide effective pain relief. ⋯ SAPB with continuous local anaesthetic infusion is an effective alternative to treat rib fracture pain when EA is contraindicated. We found that SABP significantly reduces pain in patients with unilateral MRFs, although EA achieves better analgesia over the first 12 h following the block.
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Glossopharyngeal nerve block is a useful interventional technique for pain management of the head and neck. It is performed with landmark techniques or ultrasound guidance. We propose a novel ultrasound-guided glossopharyngeal nerve block technique. ⋯ We designated the technique as ultrasound-guided selective glossopharyngeal nerve block: posterior mandibular ramus approach. No complications occurred during the bilateral application. This novel approach can be performed at a very shallow position, compared with conventional methods. There is no damage to tissues other than the muscles, which reduces postoperative complications and patient distress. Although our technique requires further safety assessments and technical refinements, it could represent a simpler alternative to conventional methods in daily clinical practice.
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The American College of Emergency Physicians (ACEP) Emergency Medicine Quality Network (E-QUAL) Opioid Initiative was launched in 2018 to advance the dissemination of evidence-based resources to promote the care of emergency department (ED) patients with opioid use disorder. This virtual platform-based national learning collaborative includes a low-burden, structured quality improvement project, data benchmarking, tailored educational content, and resources designed to support a nationwide network of EDs with limited administrative and research infrastructure. As a part of this collaboration, we convened a group of experts to identify and design a set of measures to improve opioid prescribing practices to provide safe analgesia while reducing opioid-related harms. ⋯ Measures include proportion of opioid administration in the ED, proportion of alternatives to opioids as first-line treatment, proportion of opioid prescription, opioid pill count per prescription, and patient medication safety education among ED visits for atraumatic back pain, dental pain, or headache. The proportion of benzodiazepine and opioid coprescribing for ED visits for atraumatic back pain was also evaluated. This project developed and effectively implemented a collection of 6 potential measures to evaluate opioid analgesic prescribing across a national sample of community EDs, representing the first feasibility assessment of opioid prescribing-related measures from rural and community EDs.
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The impact of benzodiazepine use on mortality in patients with chronic non-cancer pain (CNCP) has not been identified. We aimed to examine the factors associated with benzodiazepine use among patients with CNCP and examine whether long-term benzodiazepine usage is associated with mortality in patients with CNCP. ⋯ Benzodiazepine was prescribed to 2.1% of the patients with CNCP in South Korea from 2010 to 2019. Old age, increased CCI, underlying psychiatric comorbidities, and use of certain drugs are associated with increased use of benzodiazepines. In addition, benzodiazepine use is associated with 10-year all-cause mortality in patients with CNCP.
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The practice of labor analgesia is highly variable in India. Parturients are often prescribed mild opioids (tramadol and pethidine). Erector spinae plane blocks can provide widespread analgesia covering multiple dermatomes. ⋯ Outcomes included pain scores. There was a major reduction in labor pain. Erector spinae plane blocks can be part of a sustainable and effective labor analgesia service.