Articles: acute-pain.
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J. Cardiothorac. Vasc. Anesth. · Mar 2019
ReviewOpioid-Based Anesthesia and Analgesia for Adult Cardiac Surgery: History and Narrative Review of the Literature.
Opioids have played in a key role in cardiac anesthesia and analgesia since the early years of cardiac surgery. Today, opioids continue to be the primary mode for analgesia in cardiac surgery, yet there is considerable variability in the choice, dose and route of used. A history of the use of opioids in cardiothoracic anesthesia is presented, followed by an examination of the differences among current opioids in use and of outcome variables important in cardiac anesthesia, such as postoperative analgesia, extubation times, fast-track cardiac anesthesia, chronic neuropathic pain, and cardioprotection. Topical issues such as the role of perioperative opioid use in the global opioid crisis, opioid-sparing techniques and novel opioids in development are also discussed.
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The study aims were to model acute pain intensity and opioid consumption trajectories up to 72 hr after open hepatic resection, identify predictors of trajectory membership and examine the association between trajectory memberships and 6-month pain and psychological outcomes. This is a long-term analysis of a published randomized controlled trial on the impact of medial open transversus abdominis plane catheters on post-operative outcomes. ⋯ Differences in initial levels of opioid consumption and rates of change in opioid consumption shortly after surgery can help predict long-term psychological responses to pain. Identifying key characteristics associated with initial opioid consumption can lead to the development of cost-effective early interventions targeted to high risk individuals.
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Randomized Controlled Trial
Factors Associated With Acute Pain Estimation, Postoperative Pain Resolution, Opioid Cessation, and Recovery: Secondary Analysis of a Randomized Clinical Trial.
Acute postoperative pain is associated with the development of persistent postsurgical pain, but it is unclear which aspect is most estimable. ⋯ This study has shown a possible uniform predictor of remote postoperative pain, opioid use, and recovery that can be easily assessed. Future work is needed to replicate these findings.
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Best Pract Res Clin Anaesthesiol · Mar 2019
ReviewPercutaneous peripheral nerve stimulation and other alternatives for perineural catheters for postoperative analgesia.
A perineural catheter with a continuous infusion of local anesthetic is an excellent option for postoperative analgesia; however, its limitations include limited duration of action (i.e., 3-7 days) as well as a risk of infection and dislodgement. Furthermore, these blocks may cause dense sensory and motor blockades that under certain circumstances may not be ideal. ⋯ In this review, we discuss the evidence for pPNS on postoperative acute pain management. Subsequently, we briefly discuss additional alternatives to continuous peripheral nerve blocks, including cryoanalgesia and liposomal bupivacaine.
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Despite enormous differences between acute and chronic pain, the numeric pain scale (NRS) is commonly used in pain research and clinical practice for assessing the intensity of both acute and chronic pain. The use of this scale has been challenged as it may fail to accurately reflect the pure intensity of chronic pain. ⋯ The results suggest that anchoring the NRS can potentially improve the accuracy of reported chronic pain intensity.