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Latest & greatest articles for acute pain
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Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain.To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture (...) on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS.A randomized prospective double-blinded trial.Assiut University Hospitals, Orman Cardiology Hospital.Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough
Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages e47–e49 Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department (...) of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: December 11, 2018 Expand all Collapse all Article Outline Take-Home Message In adult emergency department (ED) patients with acutepain, low-dose intravenous ketamine (0.3 to 0.5 mg/kg) may provide pain relief within 10 minutes that is similar to that of single-dose intravenous morphine (0.1 mg/kg). Methods Data Sources A medical librarian searched MEDLINE, EMBASE, Scopus, Cochrane
Transition from acute to chronic pain after surgery. Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause (...) of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions
APOLLO-1: a randomized placebo and active-controlled phase III study investigating oliceridine (TRV130), a G protein-biased ligand at the micro-opioid receptor, for management of moderate-to-severe acutepain following bunionectomy Oliceridine is a novel G protein-biased µ-opioid receptor agonist designed to provide intravenous (IV) analgesia with a lower risk of opioid-related adverse events (ORAEs) than conventional opioids.APOLLO-1 (NCT02815709) was a phase III, double-blind, randomized (...) trial in patients with moderate-to-severe pain following bunionectomy. Patients received a loading dose of either placebo, oliceridine (1.5 mg), or morphine (4 mg), followed by demand doses via patient-controlled analgesia (0.1, 0.35, or 0.5 mg oliceridine, 1 mg morphine, or placebo). The primary endpoint compared the proportion of treatment responders through 48 hours for oliceridine regimens and placebo. Secondary outcomes included a composite measure of respiratory safety burden (RSB
Neuroleptanalgesia for acute abdominal pain: a systematic review Acute abdominal pain (AAP) comprises up to 10% of all emergency department (ED) visits. Current pain management practice is moving toward multi-modal analgesia regimens that decrease opioid use.This project sought to determine whether, in patients with AAP (population), does administration of butyrophenone antipsychotics (intervention) compared to placebo, usual care, or opiates alone (comparisons) improve analgesia or decrease (...) Trials Registry), relevant bibliographies, and conference proceedings were also searched. Searches were not limited by date, language, or publication status. Studies eligible for inclusion were prospective randomized clinical trials enrolling patients (age ≥18 years) with AAP treated in acute care environments (ED, intensive care unit, postoperative). The butyrophenone must have been administered either intravenously or intra-muscularly. Comparison groups included placebo, opiate only
The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials Pregabalin is commonly used as an analgesic for neuropathic pain. But pregabalin as an adjunct to a multimodal analgesic regimen - although standard clinical protocol in some settings - has remained controversial. This meta-analysis was conducted to identify the efficacy of pregabalin for management of postoperative (...) drowsiness (OR: 8.61; 95% CI: 2.23-33.20; P=0.002), and less constipation (OR: 0.23; 95% CI: 0.09-0.59; P=0.002). There was no statistical differences in pain score on 7 days (MD:-0.77; 95% CI: -2.38 to 0.84; P=0.35), nausea (OR: 0.73; 95% CI: 0.42-1.26; P=0.26), and vomiting (OR: 0.83; 95% CI: 0.36-1.90; P=0.65).Pregabalin can prevent postoperative pain in thoracotomy and decrease incidence of neuropathic pain and morphine consumption. Pregabalin may be a valuable asset in management of acute
Effects of a single dose of preoperative pregabalin and gabapentin for acute postoperative pain: a network meta-analysis of randomized controlled trials Pregabalin (PGB) and gabapentin (GBP) are current and emerging drugs in the field of pre-emptive preoperative analgesia. However, the role of PGB or GBP in acute postoperative pain management still remains elusive.We conducted a comprehensive literature search of articles published by December 3, 2017. A total of 79 randomized controlled trials (...) with 6,201 patients receiving single-dose premedication were included. Through a network meta-analysis (NMA), we validated the analgesic effect and incidence of adverse events by using various doses of PGB or GBP administration.NMA results suggested that the analgesic effect may be dose related. For 24-hour opioid consumption, a consistent decrease was found with the increase in the dose of PGB or GBP. For 24-hour pain score at rest, a high dose (≥150 mg) of PGB was more effective in decreasing pain
Randomized Clinical Trial of Intravenous Acetaminophen as an Analgesic Adjunct for Older Adults With Acute Severe Pain Older adults are at risk for undertreatment of pain. We examined intravenous (IV) acetaminophen as an analgesic adjunct to IV opioids in the care of older emergency department (ED) patients with acute severe pain.This was a randomized clinical trial conducted in two EDs in the Bronx, New York. Eligible adults aged 65 years and older with acute severe pain were randomized to 0.5 (...) in the hydromorphone + IV acetaminophen group wanted more analgesia at 60 minutes versus 29.1% in the hydromorphone + placebo group, for a difference of -0.4% (95% CI = -14.3% to 13.5%). These differences were neither clinically nor statistically significant. Safety profiles were similar in both groups.In this randomized clinical trial, the addition of IV acetaminophen to IV hydromorphone as an adjunctive analgesic for acute, severe, pain in older adults provided neither clinically nor statistically superior pain
The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomized controlled trials (RCTs) Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability
Managing acutepain in patients with opioid use disorder on medication-assisted treatment Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites
Risk factors for the development of acute post-surgical pain and the transition to chronic post-surgical pain in paediatric patients: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability
Acute and chronic painful temporomandibular disorders: a systematic review of differentiating factors and predictors of acute to chronic pain transition Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content
Perioperative intravenous ketamine for acute postoperative pain in adults. Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting.To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acutepain following general anaesthesia.We searched (...) . Studies compared ketamine with placebo, or compared ketamine plus a basic analgesic, such as morphine or non-steroidal anti-inflammatory drug (NSAID), with a basic analgesic alone.Two review authors searched for studies, extracted efficacy and adverse event data, examined issues of study quality and potential bias, and performed analyses. Primary outcomes were opioid consumption and pain intensity at rest and during movement at 24 and 48 hours postoperatively. Secondary outcomes were time to first
Effect of Intravenous Dexmedetomidine During General Anesthesia on Acute Postoperative Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Dexmedetomidine has been shown to have an analgesic effect. However, no consensus was reached in previous studies.Electronic databases such as PubMed, Embase, and Cochrane Central were searched for relevant randomized controlled trials. The relative risk and weighted mean difference (WMD) were used to analyze the outcomes (...) . Random-effects model was used for meta-analysis.Compared with the normal saline group, patients using DEX showed a significantly decreased pain intensity within 6 hours [WMD=-0.93; 95% confidence interval (CI), -1.34 to -0.53) and at 24 hours after surgery (WMD=-0.47; 95% CI, -0.83 to -0.11). DEX usage significantly reduced the cumulative opioids consumption at 24 hours after surgery (WMD=-6.76; 95% CI, -10.16 to -3.35), decreased the rescue opioids consumption in postanesthesia care unit (WMD=-3.11
Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption.Patients (N=50 (...) , 3-12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with ropivacaine 0.1% was provided. The main study outcomes were the revised Face, Legs, Activity, Cry, and Consolability pain scores, epidural ropivacaine consumption, and additional analgesic requirements during the first 48 hours
What Is the Utility of Coronary Computed Tomography Angiography Compared With Standard of Care for the Evaluation of Acute Chest Pain? (SRS diagnosis) TAKE-HOME MESSAGE Compared with existing standards of care for the evaluation of acute chest pain, coronary computed tomography (CT) angiography is associated with similar rates of major adverse events, but higher rates of revascularization. What Is the Utility of Coronary Computed Tomography Angiography Compared With Standard of Care (...) for the Evaluation of Acute Chest Pain? EBEM Commentators Michael Gottlieb, MD Chase Socha, MD Department of Emergency Medicine Rush University Medical Center Chicago, IL Results The search strategy identi?ed 648 articles, of which 10 trials (6,285 total participants) met the inclusion criteria. The studies were published between 2007 and 2016, and none were deter- mined to be at high risk of bias. Six studies were performed in the ED and 4 studies were per- formed in the inpatient setting. The mean age ranged
Randomized Controlled Trial of Intravenous Acetaminophen Versus Intravenous Hydromorphone for the Treatment of AcutePain in the Emergency Department As clinicians look to nonnarcotic analgesics in the emergency department (ED), it is essential to understand the effectiveness and adverse effects of nonopioid medications in comparison with existing opioid treatments. Studies of intravenous acetaminophen for acutepain in the ED demonstrate mixed results and suffer from small sample sizes (...) and methodological limitations. This study compares intravenous hydromorphone with intravenous acetaminophen in adult ED patients presenting with acute pain.This was a prospective, randomized, clinical trial comparing 1 g intravenous acetaminophen with 1 mg intravenous hydromorphone for treatment of adults with severe, acutepain in the ED. The primary outcome was between-group difference in change in numeric rating scale from baseline to 60 minutes postadministration of study medication. Secondary outcomes
Efficacy of hypnosis on pain, wound-healing, anxiety, and stress in children with acute burn injuries: a randomized controlled trial No randomized controlled trial has investigated the efficacy of hypnosis for reducing pain and improving wound-healing in children with burns. This randomized controlled trial aimed to investigate whether hypnosis decreases pain, anxiety, and stress and accelerates wound-healing in children undergoing burn wound procedures. Children (4-16 years) with acute burns (...) presenting for their first dressing change were randomly assigned to a Hypnosis Group who received hypnosis plus standard care or a Standard Care Group who received standard pharmacological and nonpharmacological intervention. Repeated measures of pain intensity, anxiety, stress, and wound-healing were taken at dressing changes until ≥95% wound re-epithelialization. Data for 62 children were analyzed on an intent-to-treat basis using Generalized Estimating Equations (n = 35 Standard Care Group; n = 27
A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for AcutePain in the Emergency Department Opioids are commonly prescribed in the emergency department (ED) for the treatment of acutepain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low-dose ketamine (LDK) is one opioid alternative for the treatment of acutepain in the ED.This systematic review and meta-analysis sought to quantify whether LDK is an effective and safe (...) opioid alternative for acutepain reduction in adults in the ED setting. (PROSPERO Registration Number CRD42017065303).This was a systematic review of randomized controlled trials comparing intravenous opioids to LDK for relief of acutepain in the ED. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine
Single-dose intravenous diclofenac for acute postoperative pain in adults. Postoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and, in turn, reduces the incidence and severity of opioid-induced adverse events (AEs).To assess the analgesic efficacy and adverse effects of single-dose intravenous diclofenac, compared with placebo or an active comparator, for moderate to severe postoperative pain in adults.We searched the following (...) databases without language restrictions: the Cochrane Central Register of Controlled Trials (Cochrane Register of Studies Online), MEDLINE, and Embase on 22 May 2018. We checked clinical trials registers and reference lists of retrieved articles for additional studies.We included randomized trials that compared a single postoperative dose of intravenous diclofenac with placebo or another active treatment, for treating acute postoperative pain in adults following any surgery.We used standard