Articles: pain-management-methods.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewComplications and liability related to regional and neuraxial anesthesia.
Regional anesthesia is responsible for approximately one-fifth of professional liability claims. The present investigation evaluated common and rare complications related to regional and neuraxial anesthesia, including postdural puncture headache, backache, transient neurological symptoms, inadvertent intrathecal injection, epidural hematoma and abscess, meningitis, arachnoiditis, postoperative urinary retention, local anesthetic systemic toxicity, and cardiac arrest. ⋯ This manuscript also provides an overview and analysis of the existing literature and makes some recommendations in terms of strategies to prevent or minimize the potential patient injury, with a focus on those more commonly associated with patient injury and liability exposure. The role of ultrasound in preventing patient injury during regional anesthesia is also discussed.
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Best Pract Res Clin Anaesthesiol · Dec 2019
ReviewPECS, serratus plane, erector spinae, and paravertebral blocks: A comprehensive review.
Thoracic planar blocks represent a novel and rapidly expanding facet of regional anesthesia. These recently described techniques represent the potential for excellent analgesia, enhanced technical safety profiles, and reduced physiological side effects versus traditional techniques in thoracic anesthesia. ⋯ In the present investigation, we describe the history, common indications, technique, and limitations of pectoral nerves (PECS), serratus plane, erector spinae plane, and thoracic paravertebral plane blocks. In summary, these techniques provide excellent analgesia and merit consideration in thoracic surgery.
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Review Comparative Study
Opioid Management in Older Adults with Chronic Kidney Disease: A Review.
Chronic pain, a common comorbidity of chronic kidney disease, is consistently under-recognized and difficult to treat in older adults with nondialysis chronic kidney disease. Given the decreased kidney function associated with aging and chronic kidney disease, these patients are at increased risk for drug accumulation and adverse events. Emerging research has demonstrated the efficacy of opioids in chronic kidney disease patients, but research specifically focusing on older, nondialysis chronic kidney disease patients is scarce. ⋯ Specifically, transdermal buprenorphine, transdermal fentanyl, and oral hydromorphone are the most tolerable opioids in these patients; hydrocodone, oxycodone, and methadone are useful but require careful monitoring; and tramadol, codeine, morphine, and meperidine should be avoided due to risk of accumulation and adverse events. Because older adults with nondialysis chronic kidney disease are at increased risk for adverse events, vigilant monitoring of opioid prescription is critical. Lastly, collaboration among an interprofessional clinical team can ensure safe prescription of opioids in older adults with nondialysis chronic kidney disease.
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Meta Analysis Comparative Study
Comparison of adductor canal block with periarticular infiltration analgesia in total knee arthroplasty: A meta-analysis of randomized controlled trials.
Total knee arthroplasty (TKA) is accompanied by moderate to severe postoperative pain. Multimodal analgesia, such as femoral nerve block, periarticular infiltration analgesia (PIA), and patient-controlled intravenous analgesia, have been used for postoperative analgesia. Recently, randomized controlled trials have compared the efficacy of the adductor canal block (ACB) and the PIA in patients undergoing TKA. However, there is no definite answer as to the efficacy and safety of the ACB compared with the PIA. ⋯ Our pooled data indicated the ACB group reduced the equivalent morphine consumption compared with the PIA group, with no statistically significant differences in the VAS score, quadriceps muscle strength, TUG test, complications, and LOS.
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Journal of critical care · Dec 2019
Meta AnalysisNon-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis.
To identify the impact of non-opioid analgesics as adjuvants to opioid on opioid consumption and its side effects, as well as the analgesic effectiveness in adult patients in the ICU. ⋯ Non-opioid analgesics as adjuvants to opioid reduced the consumption and the side effects of opioids in adult surgical and Guillain-Barre syndrome patients in the ICU.