Articles: pain.
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Editorial Review
Nonsteroidal anti-inflammatory drugs in the perioperative period: current controversies and concerns.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors provide significant analgesic and opioid-sparing benefits. However, these analgesics are commonly avoided owing to concerns of potential adverse effects. The evidence for NSAID-related adverse effects is conflicting and of poor quality, and these analgesics are safer than what has been implied. Thus, it is imperative that NSAIDs or COX-2-specific inhibitors are administered routinely unless there are well-founded contraindications.
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There is a complex association between postoperative pain and postoperative delirium, which highlights the need for a more balanced approach to pain management that considers various risk factors. We emphasise the importance of comprehensive documentation and standardised monitoring to improve detection and management of postoperative delirium, ultimately enhancing patient outcomes. We advocate for a precision anaesthesia approach, which tailors care to individual patient profiles, as a potential solution to address these challenges.
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A recent study in the British Journal of Anaesthesia examining trajectories of anxiety and depressive symptoms after diverse surgical procedures sheds light on an often overlooked, yet important, factor in postoperative recovery-mental health. The authors applied ecological momentary assessment to collect high-resolution data to identify and characterise a subgroup of vulnerable patients who experience worsening of psychological symptoms after surgery. The study prompts not only consideration of psychological factors, but also how best to leverage ecological momentary assessment to understand the perioperative experience.