Articles: acute-pain.
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Buprenorphine is a partial agonist at mu-opioid receptors and competes for these receptors with other opioids in vitro. Whether patients on buprenorphine maintenance require high doses of opioid analgesics to attain adequate postoperative pain control has not been determined. We evaluated differences in acute postoperative opioid consumption and pain burden between patients taking buprenorphine and those taking methadone preoperatively. ⋯ Preoperative buprenorphine use was associated with >50% reduction in postoperative opioid dose requirement and a statistically significant, though clinically unimportant, reduction in acute pain burden in comparison to methadone. The study is limited by several important factors such as the exclusion of patients requiring intravenous patient-controlled analgesia, small number of patients were on higher dose of buprenorphine, and a large percentage of methadone patients were not on a stable dose of methadone yet.
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Randomized Controlled Trial
Patient-reported outcomes, health-related quality of life, and acute medication use in patients with a ≥ 75% response to eptinezumab: subgroup pooled analysis of the PROMISE trials.
PROMISE-1 and PROMISE-2 evaluated the preventive efficacy, tolerability, and safety of eptinezumab, a calcitonin gene-related peptide-targeted monoclonal antibody, in adults with episodic (EM) and chronic migraine (CM), finding significant reductions in migraine frequency. This post hoc analysis compared patient-reported outcomes (PROs), health-related quality of life (HRQoL) and acute medication use in patients with a ≥ 75% migraine responder rate (MRR) after treatment with eptinezumab to patients with a ≥ 50- < 75% MRR. ⋯ Eptinezumab treatment induced a ≥ 75% MRR over wks1-12 in the majority of patients. This patient subgroup reported substantial improvements in PROs associated with headache-related life impact and HRQoL, and reductions in acute headache medication use, which were more marked than those in the ≥ 50-< 75% responders. This study supports the clinical meaningfulness of ≥ 75% MRR for patients with either EM or CM.
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Intravenous lignocaine has an emerging role in the treatment of acute pain within the perioperative setting, as recent consensus guidelines from the Association of Anaesthetists have shown. It has played a role in chronic pain management in recent decades, and continues to be a useful tool for pain specialists.
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Reg Anesth Pain Med · Feb 2022
Agents of change: the Gaston Labat awardees past, present, and future-the 2021 Gaston Labat Award lecture.
The prior recipients of the Gaston Labat Award can be thought of as change agents because of their driving desire to challenge and improve the status quo. All of us are interconnected and should seek to collectively work toward meaningful change in our communities. The 2021 Gaston Labat lecture pays tribute to past agents of change and inspires those to come by urging everyone to become involved in the solution.
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Randomized Controlled Trial
Ketamine Administration for Acute Painful Sickle Cell Crisis: A Randomized Controlled Trial.
The objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). ⋯ Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2-h period and reduced the cumulative morphine dose in the ED with no significant drug-related side effects in the ketamine-treated group.