Articles: acute-pain.
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Randomized Controlled Trial
A prospective, randomized comparison of ultrasonographic visualization of proximal intercostal block vs paravertebral block.
Thoracic paravertebral blockade is an accepted anesthetic and analgesic technique for breast surgery. However, real-time ultrasound visualization of landmarks in the paravertebral space remains challenging. We aimed to compare ultrasound-image quality, performance times, and clinical outcomes between the traditional parasagittal ultrasound-guided paravertebral block and a modified approach, the ultrasound-guided proximal intercostal block. ⋯ Proximal intercostal block yielded superior visualization of key anatomical landmarks, possibly offering technical advantages over traditional paravertebral nerve block.
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Opioids are the main group of pharmacological agents used during the perioperative period and provide a sedative and analgesic component. The observations of opioid consumption in West Europe indicate that this group of drugs is widely used in chronic noncancer pain therapy. ⋯ There are also questions about the immunosuppressive effects among patients receiving opioids in the treatment of chronic noncancer pain. The aim of the review article is to present information about the action of opioids on the immune system in carcinogenic settings and to define the clinical usefulness of this pharmacological phenomenon.
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For over two decades, dramatic increases in opioid prescriptions in the developed world, especially for long-term management of chronic noncancer pain, were accompanied by increases in patient harm. In recent years in the USA, opioid-related deaths rates have continued to increase despite falls in prescribing rates and deaths associated with prescription opioids. In large part, this is attributed to the growing availability of illicitly manufactured fentanyl. ⋯ Importantly, compared with opioid-naïve patients, opioid-tolerant patients may be at higher risk of opioid-induced ventilatory impairment when additional opioids are administered to manage new acute pain. For some patients, perioperative care may be best coordinated by a perioperative or post-discharge service with referral to multidisciplinary pain and addiction medicine services as indicated. Carefully planned and communicated discharge prescribing, with a weaning plan for additional opioids, is essential.
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Although percutaneous vertebroplasty (PVP) can effectively relieve the pain for patients with acute osteoporotic vertebral compression fractures (OVCFs), many patients still complain of mild back pain in the early postoperative period. ⋯ Osteoporotic vertebral compression fractures, percutaneous vertebroplasty, Numeric Rating Scale, vertebral height, responders, low responders, limited activity, complications.