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PloS One 2023Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with... (Review)
Review
BACKGROUND
Therapeutic hypothermia (TH) is a widely practiced neuroprotective strategy for neonates with hypoxic-ischemic encephalopathy. Induced hypothermia is associated with shivering, cold pain, agitation, and distress.
OBJECTIVE
This scoping review determines the breadth of research undertaken for pain and stress management in neonates undergoing hypothermia therapy, the pharmacokinetics of analgesic and sedative medications during hypothermia and the effect of such medication on short- and long-term neurological outcomes.
METHODS
We searched the following online databases namely, (i) MEDLINE, (ii) Web of Science, (iii) Cochrane Library, (iv) Scopus, (v) CINAHL, and (vi) EMBASE to identify published original articles between January 2005 and December 2022. We included only English full-text articles on neonates treated with TH and reported the sedation/analgesia strategy used. We excluded articles that reported TH on transport or extracorporeal membrane oxygenation, did not report the intervention strategies for sedation/analgesia, and reported hypoxic-ischemic encephalopathy in which hypothermia was not applied.
RESULTS
The eligible publications (n = 97) included cohort studies (n = 72), non-randomized experimental studies (n = 2), pharmacokinetic studies (n = 4), dose escalation feasibility trial (n = 1), cross-sectional surveys (n = 5), and randomized control trials (n = 13). Neonatal Pain, Agitation, and Sedation Scale (NPASS) is the most frequently used pain assessment tool in this cohort. The most frequently used pharmacological agents are opioids (Morphine, Fentanyl), benzodiazepine (Midazolam) and Alpha2 agonists (Dexmedetomidine). The proportion of neonates receiving routine sedation-analgesia during TH is center-specific and varies from 40-100% worldwide. TH alters most drugs' metabolic rate and clearance, except for Midazolam. Dexmedetomidine has additional benefits of thermal tolerance, neuroprotection, faster recovery, and less likelihood of seizures. There is a wide inter-individual variability in serum drug levels due to the impact of temperature, end-organ dysfunction, postnatal age, and body weight on drug metabolism.
CONCLUSIONS
No multidimensional pain scale has been tested for reliability and construct validity in hypothermic encephalopathic neonates. There is an increasing trend towards using routine sedation/analgesia during TH worldwide. Wide variability in the type of medication used, administration (bolus versus infusion), and dose ranges used emphasizes the urgent need for standardized practice recommendations and guidelines. There is insufficient data on the long-term neurological outcomes of exposure to these medications, adjusted for underlying brain injury and severity of encephalopathy. Future studies will need to develop framework tools to enable precise control of sedation/analgesia drug exposure customized to individual patient needs.
Topics: Infant, Newborn; Humans; Midazolam; Dexmedetomidine; Cross-Sectional Studies; Hypoxia-Ischemia, Brain; Hypothermia; Reproducibility of Results; Pain; Analgesia; Hypothermia, Induced
PubMed: 38060481
DOI: 10.1371/journal.pone.0291170 -
Zoological Research Jan 2023
Topics: Animals; Pain; Analgesia; Sound
PubMed: 36594395
DOI: 10.24272/j.issn.2095-8137.2022.524 -
Medicine Feb 2023Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression.
METHODS
A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors.
RESULTS
In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56-1.00, P = .05; I2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34-0.90, P = .02; I2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38-0.86; P = .008; I2 = 82%) at ≥4 weeks after delivery.
CONCLUSION
Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.
Topics: Pregnancy; Female; Humans; Depression, Postpartum; Pain Management; Labor, Obstetric; Analgesia; Pain; Analgesia, Epidural; Analgesia, Obstetrical
PubMed: 36827052
DOI: 10.1097/MD.0000000000033039 -
Schmerz (Berlin, Germany) Jun 2022The efficacy of pain therapies can be substantially modulated by treatment expectations, which is reflected by the substantial placebo effects observed in pain (so... (Review)
Review
BACKGROUND
The efficacy of pain therapies can be substantially modulated by treatment expectations, which is reflected by the substantial placebo effects observed in pain (so called placebo analgesia).
QUESTION
What is currently known about the neurobiological and neurochemical mechanisms underlying placebo analgesia?
MATERIALS AND METHODS
A focused presentation of key publications in the field embedded in a structured overview of the mechanistic concepts and current theories according to recent evidence.
RESULTS
Experimental studies with functional neuroimaging showed that the effect of placebo analgesia is reflected by changes in brain activity related to pain processing and cognitive control. The important neurotransmitters involved include opioids and dopamine.
CONCLUSION
Placebo analgesia is associated with complex neurobiological and -physiological mechanisms. An advanced comprehension of these processes should be applied to optimize existing and future therapeutic approaches in pain therapy.
Topics: Analgesia; Brain; Dopamine; Humans; Pain; Pain Management; Placebo Effect
PubMed: 35301592
DOI: 10.1007/s00482-022-00630-4 -
PloS One 2023Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the...
BACKGROUND
Enhanced recovery is the gold standard in modern perioperative management, including that for cesarean deliveries. However, qualitative and quantitative data on the physical and psychological recovery of women after vaginal childbirth are limited. Whether neuraxial labor analgesia influences postpartum recovery is unknown.
METHODS
Primiparous women anticipating a vaginal childbirth between January 2020 and May 2021 were enrolled. Women with major comorbidities or postpartum complications and those who underwent a cesarean delivery were excluded. Daily step count was measured using a wrist-worn activity tracker (FitbitTM Inspire HR) for 120 hours after vaginal childbirth. Subjective fatigue levels and health-related quality of life were assessed using the Multidimensional Fatigue Inventory (MFI) and EuroQol 5 Dimension 5 Level (EQ-5D-5L), respectively, at the 3rd trimester antenatal visit, on postpartum day 1 and 3, and at the one-month postpartum visit. Rest and dynamic pain scores and the location of pain were documented by participants during postpartum hospitalization.
RESULTS
Among 300 women who were enrolled antenatally, 95 and 116 had a vaginal delivery without (NCB group) and with (EPL group) epidural analgesia, respectively. The median number of steps per 24 hours increased daily in both groups, and no significant difference was detected between the groups. Postpartum pain was mild overall, with median rest and dynamic pain scores being less than 4 and similar between the groups. MFI and EQ-5D-5L scores were the worst on postpartum day 1 in both groups and gradually improved to antepartum level by the one-month postpartum visit. Higher MFI score on postpartum day 1, but not the use of epidural analgesia, was associated with lower odds of achieving adequate postpartum ambulation (defined as >3500 steps between 48 and 72 hours postpartum).
CONCLUSION
The use of epidural analgesia was not associated with worse recovery outcomes during postpartum hospitalization.
TRIAL REGISTRATION
UMIN-CTR, #UMIN000039343, registered on January 31, 2020.
Topics: Female; Pregnancy; Humans; Analgesia, Epidural; Prospective Studies; Quality of Life; Delivery, Obstetric; Pain; Parity; Analgesia, Obstetrical
PubMed: 37797060
DOI: 10.1371/journal.pone.0292393 -
Korean Journal of Anesthesiology Apr 2022Safe anesthesia is achieved using objective methods that estimate the patient's state during different phases of surgery. A patient's state under anesthesia is... (Review)
Review
Safe anesthesia is achieved using objective methods that estimate the patient's state during different phases of surgery. A patient's state under anesthesia is characterized by three major aspects, which are linked to the main effects produced by each of the families of anesthetic agents administered: hypnosis, analgesia, and muscular relaxation. While quantification techniques designed to assess muscular relaxation under neuromuscular blocking agents have a relatively long history with a high degree of standardization and understanding (e.g., the train-of-four), the knowledge and techniques used to the depth of hypnosis assessment suffer from a lesser degree in both standardization and interpretation due to brain complexity. The problem of standardization and interpretation in the analgesia and nociception assessment increases since it involves more systems, the central nervous system, and the autonomic nervous system. This helps to explain why there are multiple a priori valid approaches to develop nociception monitoring from different interpretations and physiological bases of noxious stimuli processing. Thus, in this review, the current monitoring technologies clinically available for estimating a patient's nociception under general anesthesia are described.
Topics: Analgesia; Anesthesia, General; Humans; Monitoring, Intraoperative; Nociception; Pain Management
PubMed: 35172074
DOI: 10.4097/kja.22002 -
International Urogynecology Journal Sep 2022We conducted a systematic review of the effectiveness of local preemptive analgesia for postoperative pain control in women undergoing vaginal hysterectomy. (Review)
Review
INTRODUCTION AND HYPOTHESIS
We conducted a systematic review of the effectiveness of local preemptive analgesia for postoperative pain control in women undergoing vaginal hysterectomy.
METHODS
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched systematically to identify eligible studies published through September 25, 2019. Only randomized controlled trials and systematic reviews addressing local preemptive analgesia compared to placebo at vaginal hysterectomy were considered. Data were extracted by two independent reviewers. Results were compared, and disagreement was resolved by discussion. Forty-seven studies met inclusion criteria for full-text review. Four RCTs, including a total of 197 patients, and two SRs were included in the review.
RESULTS
Preemptive local analgesia reduced postoperative pain scores up to 6 h and postoperative opioid requirements in the first 24 h after surgery.
CONCLUSION
Preemptive local analgesia at vaginal hysterectomy results in less postoperative pain and less postoperative opioid consumption.
Topics: Female; Humans; Analgesia; Analgesics, Opioid; Hysterectomy; Hysterectomy, Vaginal; Pain, Postoperative
PubMed: 34870713
DOI: 10.1007/s00192-021-04999-1 -
Presse Medicale (Paris, France : 1983) Dec 2020Since 2002, it has been unclear whether epidural analgesia (EA) could safe through a lower back tattoo. Theoretical risks of pigment tissue coring have led to... (Review)
Review
Since 2002, it has been unclear whether epidural analgesia (EA) could safe through a lower back tattoo. Theoretical risks of pigment tissue coring have led to precautionary measures and misconception that EA should be excluded. We reviewed chronologically the 18 years of medical literature summarizing the so-called risks of EA through lower back tattoo in parturient women. To date, no convincing complication has been ever reported after an EA through a tattoo. We hope this review will bring a closure to a 18-year-old "non-issue" that has poisoned and stressed unnecessarily a generation of parturient.
Topics: Analgesia, Epidural; Female; History, 21st Century; Humans; Mythology; Obstetric Labor Complications; Pregnancy; Tattooing; Therapeutic Misconception
PubMed: 32768613
DOI: 10.1016/j.lpm.2020.104050 -
Immunity, Inflammation and Disease Jul 2023We aimed to compare the labor analgesia effects of nonpharmaceutical analgesia and pharmaceutical analgesia on parturient women.
OBJECTIVE
We aimed to compare the labor analgesia effects of nonpharmaceutical analgesia and pharmaceutical analgesia on parturient women.
METHODS
One hundred and four parturient women with spontaneous births were selected and randomly divided into pharmaceutical and nonpharmaceutical analgesia groups. Before and after analgesia, the Visual Analogue Scale (VAS), parturient satisfaction with analgesia, serum pain stress factors (substance P [SP], neuropeptide Y [NPY], nerve growth factor [NGF], and prostaglandin E2 [PGE2]), duration of labor, vaginal bleeding at 2 h postpartum, postpartum urinary retention and dysuria incidence, Apgar score of 1 min and 5 min after birth, and neonatal cord blood gas analysis (pH, partial pressure of oxygen [PO ], partial pressure of carbon dioxide [PCO ], and lactate [Lac]) were compared in the two groups.
RESULTS
VAS scores were lower and the analgesia satisfaction was higher in the pharmaceutical analgesia group than in the nonpharmaceutical analgesia group (all p < .05). Serum levels of SP, NPY, NGF, and PGE2 in the pharmaceutical analgesia group were lower than those in the nonpharmaceutical analgesia group (all p < .05). The first and second stages of labor were longer and the bleeding volume at 2 h postpartum was greater in the pharmaceutical analgesia group than those in the nonpharmaceutical analgesia group (all p < .05). Reduced Lac and PCO levels and increased PO level were found in the pharmaceutical analgesia group in comparison to the nonpharmaceutical analgesia group (all p < .05).
CONCLUSION
This study demonstrates that the analgesic effect and neonatal condition of the pharmaceutical analgesia are better than the nonpharmaceutical analgesia, but the labor duration and postpartum bleeding volume of the pharmaceutical analgesia are greater than those of the nonpharmaceutical analgesia.
Topics: Infant, Newborn; Female; Humans; Dinoprostone; Nerve Growth Factor; Analgesia, Epidural; Analgesia, Obstetrical; Pain; Analgesics; Pharmaceutical Preparations
PubMed: 37506154
DOI: 10.1002/iid3.869 -
JAMA Sep 2021
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Autism Spectrum Disorder; Female; Humans; Labor, Obstetric; Pregnancy
PubMed: 34581752
DOI: 10.1001/jama.2021.15369