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Journal of the American College of... May 2021It is increasingly recognized that non-opioid analgesia is an important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is increasingly recognized that non-opioid analgesia is an important analgesia in the perioperative period. Specifically, NSAIDs (nonsteroidal anti-inflammatory drugs) have been touted as an adjunct, or even replacement, for opioids. However, uptake of NSAIDs has been slow due to concern for side effects, including bleeding. We sought to understand the risk of bleeding caused by NSAIDs in the perioperative period.
STUDY DESIGN
A physician-librarian team performed a search of electronic databases (MEDLINE, EMBASE), using search terms covering the targeted intervention (use of NSAIDs) and outcomes of interest (surgical complications, bleeding), limited to English language articles of any date. We performed a systematic review and meta-analysis of the data.
RESULTS
A total of 2,521 articles were screened, and 229 were selected on the basis of title and abstract for detailed assessment. Including reference searching, 74 manuscripts met inclusion criteria spanning years 1987-2019. These studies included 151,031 patients. Studies included 12 types of NSAIDs, the most common being ketorolac, diclofenac, and ibuprofen, over a wide-range of procedures, from otorhinolaryngology (ENT), breast, abdomen, plastics, and more. More than half were randomized control trials. The meta-analyses for hematoma, return to the operating room for bleeding, and blood transfusions showed no difference in risk in any of 3 categories studied between the NSAID vs non-NSAID groups (p = 0.49, p = 0.79, and p = 0.49, respectively). Quality scoring found a wide range of quality, with scores ranging from lowest quality of 12 to highest quality of 25, out of a total of 27 (average = 16).
CONCLUSIONS
NSAIDs are unlikely to be the cause of postoperative bleeding complications. This literature covers a large number of patients and remains consistent across types of NSAIDs and operations.
Topics: Analgesia; Anti-Inflammatory Agents, Non-Steroidal; Blood Loss, Surgical; Blood Transfusion; Diclofenac; Humans; Ibuprofen; Ketorolac; Pain, Postoperative; Pain, Procedural; Perioperative Period; Postoperative Hemorrhage; Surgical Procedures, Operative; Treatment Outcome
PubMed: 33515678
DOI: 10.1016/j.jamcollsurg.2021.01.005 -
Ginekologia Polska 2021Labor pain is not only an unpleasant mental experience, but one of the most important factors that may negatively affect the course of labor and the well-being of the...
Labor pain is not only an unpleasant mental experience, but one of the most important factors that may negatively affect the course of labor and the well-being of the fetus. Over the years, many techniques for relieving labor pain have been developed, ranging from non-pharmacological (acupuncture, TENS, hypnosis...), through opioids and aeriform anesthetics, to regional analgesia techniques. Numerous studies and meta-analyzes prove that central blockades are the gold standard of labor analgesia and debunk the myths that these blockages are negatively limited to the course of labor. In the light of recent studies, the claim that epidural analgesia increases the risk of termination by caesarean section should be rejected. It has also been proven that central blockades do not lower the child's APGAR score. Feeling, an indication to use a central block during labor, should be a subjective intolerance to pain and the wishes of the mother in labor. The review presents the directions of development and the current state of knowledge of modern medicine regarding various anesthesia techniques, their safety for the mother, fetus and newborn, as well as practical tips to increase the satisfaction of the mother in labor.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Anesthesia; Cesarean Section; Child; Female; Humans; Infant, Newborn; Labor Pain; Pregnancy; Pregnant Women
PubMed: 34747002
DOI: 10.5603/GP.a2021.0062 -
Medicina (Kaunas, Lithuania) Sep 2023In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency... (Review)
Review
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.
Topics: Humans; Pain Management; Acute Pain; Analgesics, Opioid; Analgesia; Emergency Service, Hospital
PubMed: 37893464
DOI: 10.3390/medicina59101746 -
Journal of Feline Medicine and Surgery Nov 2020Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part... (Review)
Review
PRACTICAL RELEVANCE
Procedural sedation and analgesia (PSA) describes the process of depressing a patient's conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA.
CLINICAL CHALLENGES
Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat's health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized.
AIMS
This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.
Topics: Analgesia; Anesthesia; Animals; Cats; Conscious Sedation; Risk Factors
PubMed: 33100168
DOI: 10.1177/1098612X20965830 -
ILAR Journal Dec 2020Anesthetic and analgesics are essential components of both clinical and research procedures completed in marmosets. A review of current anesthetic and analgesic regimens... (Review)
Review
Anesthetic and analgesics are essential components of both clinical and research procedures completed in marmosets. A review of current anesthetic and analgesic regimens for marmosets has been complied to provide a concise reference for veterinarians and investigator teams. Published dose regimens for injectable and inhalant anesthetic drugs and analgesic drugs are included. Appropriate physiological monitoring is key to the success of the procedure and perianesthetic options are provided. Although recent publications have refined anesthesia and analgesia practices, our review demonstrates the continued need for evidence-based resources specific to marmosets.
Topics: Analgesia; Analgesics; Anesthesia; Animals; Callithrix; Pain
PubMed: 33580955
DOI: 10.1093/ilar/ilab001 -
The Veterinary Clinics of North... Jan 2020Treatment of avian renal disease relies on supportive care, such as fluid therapy and nutritional support. Analgesia and adaptations of the environment are indicated in... (Review)
Review
Treatment of avian renal disease relies on supportive care, such as fluid therapy and nutritional support. Analgesia and adaptations of the environment are indicated in cases of renal disease associated with painful joints. Other treatments vary with the underlying etiology and may include systemic antibiotics, antifungal therapy, vitamin A supplementation, or chelation therapy.
Topics: Analgesia; Animals; Bird Diseases; Birds; Fluid Therapy; Humans; Kidney Diseases; Nutritional Support; Pain
PubMed: 31759453
DOI: 10.1016/j.cvex.2019.08.004 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Orthopedic surgery can lead to pain that is poorly if at all explicable, both in the immediate postoperative period and at longer term, impairing the surgical result and... (Review)
Review
Orthopedic surgery can lead to pain that is poorly if at all explicable, both in the immediate postoperative period and at longer term, impairing the surgical result and necessitating a multidisciplinary approach of multimodal analgesia throughout the patient's care pathway. Preoperatively, patients at high risk of postoperative pain need to be identified and referred to a pain specialist to optimize pain management. Surgical and anesthesiological measures then need to be taken intraoperatively to limit the risk of pain. Finally, and most importantly, when pain does occur postoperatively, the surgeon needs to be able to treat any obvious cause and then rapidly to call in a pain specialist to identify the underlying causes and treat them effectively.
Topics: Analgesia; Humans; Orthopedic Procedures; Pain Management; Pain Measurement; Pain, Postoperative
PubMed: 31843513
DOI: 10.1016/j.otsr.2019.05.027 -
JAMA Network Open Jun 2023Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of...
IMPORTANCE
Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists.
OBJECTIVE
To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022.
EXPOSURES
Reduction of ileocolic intussusception.
MAIN OUTCOMES AND MEASURES
The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception.
RESULTS
We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant.
CONCLUSIONS AND RELEVANCE
This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.
Topics: Male; Child; Humans; Adolescent; Female; Analgesics, Opioid; Intussusception; Cross-Sectional Studies; Intestinal Perforation; Analgesia
PubMed: 37285152
DOI: 10.1001/jamanetworkopen.2023.17200 -
JAMA Network Open Jul 2022
Topics: Analgesia; Analgesics, Opioid; Humans; Pain, Postoperative
PubMed: 35849402
DOI: 10.1001/jamanetworkopen.2022.21441 -
British Journal of Anaesthesia Aug 2021
Topics: Aldehyde Dehydrogenase, Mitochondrial; Analgesia; Animals; Ethanol; Humans; Pain Management; Wine
PubMed: 34090680
DOI: 10.1016/j.bja.2021.05.003