Articles: postoperative.
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Review
Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia.
Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. ⋯ Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.
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Randomized Controlled Trial Clinical Trial
Analgesic efficacy of erector spinae plane block in percutaneous nephrolithotomy : A randomized controlled trial.
The postoperative pain in percutaneous nephrolithotomy (PCNL) is due to dilatation of the renal capsule and the parenchymal tract. The aim of the study was to evaluate the analgesic effect of preoperative single-shot ultrasound(US)-guided erector spinae plane block (ESPB) at theT11 vertebral level in patients undergoing PCNL. ⋯ The use of US-guided ESPB provides a good postoperative analgesia and decreases opioid consumption over 24 h in patients undergoing PCNL.
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Anesth Pain Med (Seoul) · Oct 2019
Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty.
Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee. ⋯ This study showed that there was an increase of morphine equivalent consumption during POD 0-3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.
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Meta Analysis
Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis.
Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. ⋯ Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.
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Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1-4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. ⋯ Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.