Effect of magnetic nanoparticles containing ropivacaine on ankle nerve block in rats

Ropivacaine (RVC), a common pain management drug used for clinical anesthesia and postoperative analgesia, inhibits peripheral nociceptive pain stimulation. However, the potential neurological damage resulting from RVC use must be considered. Developing a strategy to enhance the local anesthetic effect of RVC while reducing its potential acute toxicity to the central nervous system is urgently needed. In this study, a novel RVC nanocomposite drug, magnetic iron oxide/polyethylene glycol-carboxymethyl chitosan/ropivacaine nanoparticle (mCMCS-PEG/RVC NPs), was synthesized with magnetic iron oxide. The inherent shell–core structure of mCMCS-PEG retained core magnetic properties, improved the stability and biocompatibility of magnetic nanoparticles, and avoided excessive degradation. Thus, mCMCS-PEG/RVC NPs are expected to provide a new pain management strategy for perioperative patients.

Total pancreatectomy with islet autotransplantation – a new pain management strategy in chronic pancreatitis?

I haven't attached an abstract, since the author guidelines page says: "An abstract is not required for the surgical case study".

Online Opioid Stewardship Training for Long-Term Care Staff

Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

An audience survey of practice relating to pain in the management of chronic venous leg ulcers

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

Nasal Nalbuphine Analgesia in Prehospital Trauma Management by First-Responder Personnel on Ski Slopes in Switzerland

Background Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in trauma. Due to the mountainous topography, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders (FR) may improve overall treatment. We therefore assessed the use of nasally administered Nalbuphine as analgesic treatment in trauma patients by FR at various skis resort in Switzerland.Methods This observational study examined a cohort of 267 patients given Nalbuphine by FR in various ski resorts in Switzerland. All FR were instructed how to administer Nalbuphine before treating patients. A treatment algorithm was developed and distributed to assure that Nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of Nalbuphine were collected on-site. Refills were handed out with each completed questionnaire.Results Nalbuphine decreased the level of pain statistically significant and clinically relevant by a median of 3 units on the NRS for pain. The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain level. Nalbuphine was less effective in patients aged 20-60 years compared to the adolescent population. No major side effects were observed.Conclusion Nasal Nalbuphine by FR was a noninvasive pain management strategy that provided safe and effective analgesia in prehospital, acute­ly injured patients. This may be an alternative method especially in circumstances of severe pain and prolonged time between arrival of the FR and arrival of EMS / HEMS personnel on scene.

Analgesics

It is the responsibility of the professional care team to develop an effective person-centred Pain Management strategy which appropriately assesses patients, analyses the results of the assessment and devises a person centred plan to manage pain while allowing the person to remain as independent and functional as possible. The medications useful in treating acute pain are similar to those used in treating other types of pain. The World Health Organization (WHO) analgesic ladder developed for treating patients with cancer pain also provides a useful approach to treat acute pain. At the lowest level (mild pain) are recommended nonopioid analgesics such as paracetamol or/plus nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprophen). Such drugs have an analgesic ceiling; above a certain dose, no further analgesia is expected. For moderate pain, are recommended combining paracetamol and/or a NSAID with an opioid (a weak opoid). The inclusion of paracetamol limits the amount of opoids that should be used within 24 hour period, with many benefits which will be discussed later in the chapter. For severe level of pain, a strong opoid such as morphine is a better choice; such opoids have no analgesic ceiling. Most postoperative or trauma patients initially respond better to a morphine-equivalent opoid. At the moment when the patient is eating and drinking, a combination of oral analgesics including opoids and paracetamol plus/minus NSAID are most of the time an adequate choice.