Articles: postoperative-pain.
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Acute postoperative pain is one of the most common challenges faced by patients who undergo surgery. Multimodal analgesia has been recommended in recent years to effectively control this condition. Nerve blocks are an important part of multimodal analgesia; a single peripheral nerve block is widely used in clinical practice. To prolong the analgesic duration of a single nerve block, adjuvants with different mechanisms, dosages, or administration routes are added to local anesthetics; however, it is not clear which adjuvant or combination is better. ⋯ Adjuvants with diverse mechanisms of action can variably extend the duration of local anesthetic effects. When utilizing adjuvants in conjunction with local anesthetics, perineural dexmedetomidine (1 mu-g/kg) or intravenous dexamethasone (10 mg) may be preferable, considering their efficacy and side effects. Current research suggests that the combination of perineural dexmedetomidine (1 mu-g/kg) and intravenous dexamethasone (10 mg) is more effective than either dexmedetomidine or dexamethasone alone.
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Randomized Controlled Trial
The effect of a subclinical dose of esketamine on depression and pain after cesarean section: A prospective, randomized, double-blinded controlled trial.
The aim of this randomized, double-blind placebo-controlled clinical trial was to study the effects of subclinical doses of esketamine on postpartum depression and pain following elective cesarean sections. ⋯ Subclinical doses of esketamine did not reduce the incidence of PPD at 14 days postpartum but did significantly lower VAS scores at 24 hours post-surgery. The experimental group experienced temporary increases in adverse reactions and Ramsay sedation scores shortly after administration.
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In the randomized, phase 3, SUSA-301 trial, celecoxib-tramadol co-crystal (CTC) provided significantly greater analgesia compared with celecoxib, tramadol, or placebo in adults with acute, moderate-to-severe, postoperative pain. This post hoc, secondary analysis further evaluated the use of rescue medication and the incidence of treatment-emergent adverse events (TEAEs). ⋯ Celecoxib-tramadol co-crystal was associated with reduced rescue medication use and an acceptable tolerability profile compared with tramadol or celecoxib alone in adults with acute, moderate-to-severe, postoperative pain.
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J Coll Physicians Surg Pak · Nov 2024
Randomized Controlled TrialEffects of Small-Dose Esketamine on Postoperative Analgaesia and Sleep Quality in Patients with Total Hip Replacement.
To determine the effect of esketamine in patient-controlled analgaesia after hip replacement on postoperative pain and improve sleep quality in patients. ⋯ Arthroplasty, Postoperative analgaesia, Esketamine, Sleep quality, Patient-controlled analgaesia.
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States have implemented policies to decrease clinically unnecessary opioid prescribing, but few studies have examined how state policies affect opioid dispensing rate trends for surgical patients. ⋯ While we observed a slight increase in the rate of Medicare beneficiaries dispensed opioids perioperatively and a substantial decrease in MMED and days' supply for those receiving opioids, state policies examined had relatively modest effects on the main measures. Our findings suggest that these state policies may have a limited impact on opioid dispensing for a patient population that is commonly dispensed opioid analgesics to help control surgical pain, and as a result may have little direct effect on clinical outcomes for this population. Changes in opioid dispensing for this population may be the result of broader societal trends than such state policies.