Articles: opioid.
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Practice Guideline
ENA Clinical Practice Guideline Synopsis: Alternatives to Opioids.
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Minerva anestesiologica · Oct 2024
Ropivacaine and magnesium sulfate in sciatic nerve block at the popliteal level: randomized double-blind study.
Following surgical procedures, over 80% of patients experience acute pain, with half of them expressing dissatisfaction with pain relief. The modern approach to surgical treatment and pain management increasingly relies on implementing multimodal analgesia, which includes the use of adjuvants in addition to long-acting local anesthetics (such as ropivacaine). This double-blind randomized study evaluated the analgesic effect of magnesium sulfate added to ropivacaine in the sciatic nerve block at the popliteal level for bunion correction surgery. ⋯ Our results suggest that magnesium added to the local anesthetic extends sensory block duration, reduces postoperative pain, improves the quality of analgesia, decreases the need for additional opioids. Further studies are needed to confirm these preliminary findings.
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Anesthesia and analgesia · Oct 2024
A Randomized, Controlled Trial of Palonosetron Versus Ondansetron for Nausea, Vomiting, and Pruritus in Cesarean Delivery with Intrathecal Morphine.
Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. Postoperative nausea and vomiting (PONV) and pruritus occur in up to 80% and 83% of patients, respectively, after cesarean delivery with intrathecal opioids. Ondansetron is the recommended medication for PONV prophylaxis, but palonosetron, a second-generation 5-HT3 receptor antagonist, has a higher receptor affinity and a longer half-life. However, studies on palonosetron use in cesarean deliveries are limited. This study aimed to determine whether palonosetron was more effective than ondansetron in preventing intrathecal morphine-induced PONV and pruritus in cesarean deliveries. ⋯ Palonosetron effectively prevents intrathecal morphine-induced PONV and pruritus during cesarean delivery. However, the efficacy of palonosetron is not significantly different from that of ondansetron.
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Although opioids continue to be used internationally for noncancer pain, evidence to date on the comparative safety of different opioids is sparse and conflicting. The aim of this study was to examine the comparative risk of all-cause mortality in patients newly initiated on opioids for noncancer pain, across 3 jurisdictions in the United Kingdom (UK), United States, and Canada. A multicentre retrospective, population-based cohort study was conducted. ⋯ In addition, other factors associated with higher mortality were being on combination opioids, fentanyl, buprenorphine, and oxycodone. Compared with those on <50 morphine milligram equivalents/day, patients on higher-doses experience an incremental increase in risk. In new users of opioids, compared with codeine, strong opioids, including morphine, fentanyl, buprenorphine, oxycodone, and combination opioids, and those on ≥50 morphine milligram equivalent/day were associated with a higher subsequent risk of all-cause mortality.