Analgesics in anaesthetic practice

2017 ◽  
Author(s):  
John Williams ◽  
Francis Bonnet
Keyword(s):  
Postoperative Pain ◽  
Opioid Analgesic ◽  
Postoperative Outcome ◽  
Perioperative Period ◽  
Well Being ◽  
Number Needed To Treat ◽  
Analgesic Agents ◽  
The Central Nervous System ◽  
Sensory Consequence ◽  
History Of Use

Each year, approximately 230 million major surgical procedures are undertaken worldwide, with over three-quarters of the patients complaining of pain postoperatively and 10% complaining of severe pain. Pain is not, however, just an unpleasant sensory consequence of surgery, but can also have significant physiological implications impacting negatively on well-being and postoperative outcome. Postoperative pain may also result in changes within the central nervous system, leading to the development of chronic pain states lasting in excess of 3–6 months. Adequate analgesia has proven to be effective when employed in the perioperative period at combating many of these adverse effects. An understanding of the basic physiological and pharmacological mechanisms responsible for producing, transmitting, and sustaining pain has allowed for a variety of effective analgesic agents to be fashioned and used clinically to treat pain. Morphine, the archetypal opioid analgesic, is the most familiar of these agents with a long history of use and evidence of effectiveness; morphine possesses a number-needed-to-treat (NNT) to reduce pain by 50% of around 3 when given in doses of between 10 and 15 mg. Non-steroidal agents and paracetamol are similarly effective in the immediate postoperative period with NNTs of between 2 and 4. More recently, a number of analgesic adjuncts such as gabapentin, pregabalin, ketamine, clonidine, and nefopam have found favour for the treatment of acute postoperative pain. None of these agents, however, are without side-effects, ensuring that the search for effective analgesic agents continues to be a vibrant area of research with new analgesic agents continuing to be developed.

Transmodulation of Dopaminergic Signaling to Mitigate Hypodopminergia and Pharmaceutical Opioid-induced Hyperalgesia

2020 ◽  
Vol 9 (3) ◽  
pp. 164-184
Author(s):  
Raymond Brewer ◽  
Kenneth Blum ◽  
Abdalla Bowirrat ◽  
Edward J. Modestino ◽  
David Baron ◽  
...  
Keyword(s):  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Well Being ◽  
Deficiency Syndrome ◽  
Pain Tolerance ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Analgesic Agents ◽  
Opioid Induced Hyperalgesia ◽  
Intensive Investigation

Neuroscientists and psychiatrists working in the areas of “pain and addiction” are asked in this perspective article to reconsider the current use of dopaminergic blockade (like chronic opioid agonist therapy), and instead to consider induction of dopamine homeostasis by putative pro-dopamine regulation. Pro-dopamine regulation could help pharmaceutical opioid analgesic agents to mitigate hypodopaminergia-induced hyperalgesia by inducing transmodulation of dopaminergic signaling. An optimistic view is that early predisposition to diagnosis based on genetic testing, (pharmacogenetic/pharmacogenomic monitoring), combined with appropriate urine drug screening, and treatment with pro-dopamine regulators, could conceivably reduce stress, craving, relapse, enhance well-being and attenuate unwanted hyperalgesia. These concepts require intensive investigation. However, based on the rationale provided herein, there is a good chance that combining opioid analgesics with genetically directed pro-dopamine-regulation using KB220 (supported by 43 clinical studies). This prodopamine regulator may become a front-line technology with the potential to overcome, in part, the current heightened rates of chronic opioid-induced hyperalgesia and concomitant Reward Deficiency Syndrome (RDS) behaviors. Current research does support the hypothesis that low or hypodopaminergic function in the brain may predispose individuals to low pain tolerance or hyperalgesia.

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

scholarly journals Purely laparoscopic feeding jejunostomy: a procedure which deserves more attention

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hsin-I. Tsai ◽  
Ta-Chun Chou ◽  
Ming-Chin Yu ◽  
Chun-Nan Yeh ◽  
Meng-Ting Peng ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Intraoperative Complications ◽  
Postoperative Outcome ◽  
Early Enteral Nutrition ◽  
Chang Gung Memorial Hospital ◽  
Open Approach ◽  
Feeding Jejunostomy ◽  
Laparoscopic Jejunostomy ◽  
Conventional Open Approach ◽  
Laparoscopic Feeding Jejunostomy

Abstract Background Laparoscopic procedure has inherent merits of smaller incisions, better cosmesis, less postoperative pain, and earlier recovery. In the current study, we presented our method of purely laparoscopic feeding jejunostomy and compared its results with that of conventional open approach. Methods We retrospectively reviewed our patients from 2012 to 2019 who had received either laparoscopic jejunostomy (LJ, n = 29) or open ones (OJ, n = 94) in Chang Gung Memorial Hospital, Linkou. Peri-operative data and postoperative outcomes were analyzed. Results In the current study, we employed 3-0 Vicryl, instead of V-loc barbed sutures, for laparoscopic jejunostomy. The mean operative duration of LJ group was about 30 min longer than the OJ group (159 ± 57.2 mins vs 128 ± 34.6 mins; P = 0.001). There were no intraoperative complications reported in both groups. The patients in the LJ group suffered significantly less postoperative pain than in the OJ group (mean NRS 2.03 ± 0.9 vs. 2.79 ± 1.2; P = 0.002). The majority of patients in both groups received early enteral nutrition (< 48 h) after the operation (86.2% vs. 74.5%; P = 0.143). Conclusions Our study demonstrated that purely laparoscopic feeding jejunostomy is a safe and feasible procedure with less postoperative pain and excellent postoperative outcome. It also provides surgeons opportunities to enhance intracorporeal suture techniques.

scholarly journals Neurological and mental health consequences of COVID-19: potential implications for well-being and labor force

2021 ◽  
Author(s):  
I B Meier ◽  
C Vieira Ligo Teixeira ◽  
I Tarnanas ◽  
F Mirza ◽  
L Rajendran
Keyword(s):  
Mental Health ◽  
Central Nervous System ◽  
Nervous System ◽  
Cognitive Impairment ◽  
Immune Cell ◽  
Previous History ◽  
Well Being ◽  
Acute Disseminated Encephalomyelitis ◽  
The Central Nervous System ◽  
Neurological Protection

Abstract Recent case studies show that the SARS-CoV-2 infectious disease, COVID-19, is associated with accelerated decline of mental health, in particular, cognition in elderly individuals, but also with neurological and neuropsychiatric illness in young people. Recent studies also show a bidirectional link between COVID-19 and mental health in that people with previous history of psychiatric illness have a higher risk for contracting COVID-19 and that COVID-19 patients display a variety of psychiatric illnesses. Risk factors and the response of the central nervous system to the virus show large overlaps with pathophysiological processes associated with Alzheimer’s disease, delirium, post-operative cognitive dysfunction and acute disseminated encephalomyelitis, all characterized by cognitive impairment. These similarities lead to the hypothesis that the neurological symptoms could arise from neuroinflammation and immune cell dysfunction both in the periphery as well as in the central nervous system and the assumption that long-term consequences of COVID-19 may lead to cognitive impairment in the well-being of the patient and thus in today’s workforce, resulting in large loss of productivity. Therefore, particular attention should be paid to neurological protection during treatment and recovery of COVID-19, while cognitive consequences may require monitoring.

Are we Ready for a “Microbiome-Guided Behaviour” Approach?

2019 ◽  
Vol 28 (04) ◽  
pp. 708-724
Author(s):  
ANDREA LAVAZZA ◽  
VITTORIO A. SIRONI
Keyword(s):  
Fecal Microbiota Transplantation ◽  
Negative Attitude ◽  
Well Being ◽  
Fecal Microbiota ◽  
Point Of View ◽  
Brain Functioning ◽  
The Central Nervous System ◽  
The Individual ◽  
The Right ◽  
The Mind

Abstract:The microbiome is proving to be increasingly important for human brain functioning. A series of recent studies have shown that the microbiome influences the central nervous system in various ways, and consequently acts on the psychological well-being of the individual by mediating, among others, the reactions of stress and anxiety. From a specifically neuroethical point of view, according to some scholars, the particular composition of the microbiome—qua microbial community—can have consequences on the traditional idea of human individuality. Another neuroethical aspect concerns the reception of this new knowledge in relation to clinical applications. In fact, attention to the balance of the microbiome—which includes eating behavior, the use of psychobiotics and, in the treatment of certain diseases, the use of fecal microbiota transplantation—may be limited or even prevented by a biased negative attitude. This attitude derives from a prejudice related to everything that has to do with the organic processing of food and, in general, with the human stomach and intestine: the latter have traditionally been regarded as low, dirty, contaminated and opposed to what belongs to the mind and the brain. This biased attitude can lead one to fail to adequately consider the new anthropological conceptions related to the microbiome, resulting in a state of health, both physical and psychological, inferior to what one might have by paying the right attention to the knowledge available today. Shifting from the ubiquitous high-low metaphor (which is synonymous with superior-inferior) to an inside-outside metaphor can thus be a neuroethical strategy to achieve a new and unbiased reception of the discoveries related to the microbiome.

Transversus abdominis block utilizing liposomal bupivacaine as a non-opioid analgesic for postoperative pain management

2018 ◽  
Vol 33 (8) ◽  
pp. 2657-2662 ◽  
Author(s):  
Thomas C. Robertson ◽  
Kathryn Hall ◽  
Susan Bear ◽  
Kyle J. Thompson ◽  
Timothy Kuwada ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Opioid Analgesic ◽  
Postoperative Pain Management ◽  
Transversus Abdominis ◽  
Liposomal Bupivacaine

scholarly journals Az ortopédiai nagyműtétek során alkalmazott terápiás szuggesztiók hatása a beteg gyógyulására

2018 ◽  
Vol 159 (48) ◽  
pp. 2011-2020 ◽  
Author(s):  
Csenge Szeverényi ◽  
Zoltán Csernátony ◽  
Ágnes Balogh ◽  
Tünde Simon ◽  
Zoltán Kekecs ◽  
...  
Keyword(s):  
Perioperative Period ◽  
Well Being ◽  
Controlled Study ◽  
Control Group ◽  
Physician Communication ◽  
Replacement Surgery ◽  
Randomized Controlled ◽  
Medication Consumption ◽  
Communication Method ◽  
The Mean

Abstract: Introduction and aim: Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients’ recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient–physician communication. Method: In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery. Results: Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p<0.001] and 4th [0.97 (0.23; 1.7); p = 0.011] postoperative day and less transfusion had to be administered (OR: 2.37; p = 0.004). However, there was no difference between the two groups in the postoperative need of medications, in the length of hospitalisation and in the frequency of complications. Conslusion: Our results indicate that the administration of therapeutic suggestions in the perioperative period may be beneficial for orthopaedic surgery patients. Orv Hetil. 2018; 159(48): 2011–2020.

scholarly journals Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

2021 ◽  
Author(s):  
Peter Magnusson ◽  
Jo Ann LeQuang ◽  
Joseph V. Pergolizzi
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Electronic Device ◽  
Perioperative Period ◽  
Cardiac Implantable Electronic Device ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Device Implantation ◽  
Analgesic Regimen ◽  
Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

scholarly journals Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL)

2015 ◽  
Vol 5 (1) ◽  
pp. 6-9
Author(s):  
Vani Sabesan ◽  
Timothy R Jelsema ◽  
Daniel J Lombardo
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Well Being ◽  
Multimodal Approach ◽  
Wound Infiltration ◽  
Nerve Blocks ◽  
Liposomal Bupivacaine ◽  
Postsurgical Pain ◽  
Limited Efficacy

ABSTRACT Adequate postoperative pain management after an orthopaedic procedure is critical for patient well-being, acceptable clinical outcomes and patient satisfaction. Current literature suggests over 80% of surgical patients’ state they have moderate to severe pain within 24 hours postoperatively. The standard in pain management for more than 40 years has been opioids, medications known for their many adverse effects and limited efficacy. Recently, a multimodal approach to pain control has been sought after for optimal postoperative pain management. This approach utilizes multiple methods of pain management, such as nerve blocks, wound infiltration with local anesthetics and oral analgesics, to concomitantly reduce postoperative pain. Liposomal bupivacaine, EXPAREL, has been shown to reduce pain for as long as 96 hours postoperatively in select studies. These studies have included both hard and soft-tissue procedures. The goal of this review is to examine the literature on EXPAREL and provide a comprehensive presentation for orthopaedic surgeons to apply to their practices. Sabesan V, Jelsema TR, Lombardo DJ. Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL). The Duke Orthop J 2015;5(1):6-9.

Postoperative Pain and Opioid Analgesic Requirements After Orthognathic Surgery

2018 ◽  
Vol 76 (11) ◽  
pp. 2285-2295 ◽  
Author(s):  
Ashkan Mobini ◽  
Pushkar Mehra ◽  
Radhika Chigurupati
Keyword(s):  
Postoperative Pain ◽  
Orthognathic Surgery ◽  
Opioid Analgesic
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