Articles: opioid.
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Observational Study
Understanding the Natural History of Postoperative Pain and Patient-Reported Opioid Consumption After Elective Spine and Nerve Surgeries With an Automated Text Messaging System.
There is a gap in understanding how to ensure opioid stewardship while managing postoperative neurosurgical pain. ⋯ Using real-time, patient-centered pain assessment and opioid consumption data will allow for the development of evidence-based opioid prescribing guidelines after spinal and nerve surgery.
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Review Meta Analysis
Analgesic use and associated adverse events in patients with chronic kidney disease: a systematic review and meta-analysis.
Treating pain in the context of chronic kidney disease (CKD) is challenging because of altered pharmacokinetics and pharmacodynamics, with an increased risk of toxicity and drug adverse events in this population. The aims of this systematic review and meta-analysis were to assess the prevalence of analgesic use and establish the risk of analgesics-related adverse events, in patients with CKD. ⋯ CRD42019156491 (PROSPERO).
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Randomized Controlled Trial Comparative Study
Interscalene Brachial Plexus Block with Liposomal Bupivacaine versus Standard Bupivacaine with Perineural Dexamethasone: A Noninferiority Trial.
The interscalene nerve block provides analgesia for shoulder surgery. To extend block duration, provide adequate analgesia, and minimize opioid consumption, the use of adjuvants such as dexamethasone as well as the application of perineural liposomal bupivacaine have been proposed. This randomized, double-blinded, noninferiority trial hypothesized that perineural liposomal bupivacaine is noninferior to standard bupivacaine with perineural dexamethasone in respect to average pain scores in the first 72 h after surgery. ⋯ Interscalene nerve blocks with perineural liposomal bupivacaine provided effective analgesia similar to the perineural standard bupivacaine with dexamethasone. The results show that bupivacaine with dexamethasone can be used interchangeably with liposomal bupivacaine for analgesia after shoulder surgery.
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Anaesth Intensive Care · Mar 2022
ReviewThe complications of opioid use during and post-intensive care admission: A narrative review.
Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. ⋯ Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.