Pain
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The aim of this systematic review is to assess the effectiveness of acupuncture as an adjunctive analgesic method to standard anaesthetic procedures for surgery and to determine whether acupuncture has any analgesic-sparing effect. Electronic literature searches for randomised clinical trials (RCTs) of acupuncture during surgery were performed in seven electronic databases. No language restrictions were imposed. ⋯ Strong evidence exists that real acupuncture is not significantly different from placebo acupuncture. For an analgesic-sparing effect of acupuncture, evidence remains inconclusive. In conclusion, this review does not support the use of acupuncture as an adjunct to standard anaesthetic procedures during surgery.
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Review Comparative Study
Ketamine and postoperative pain--a quantitative systematic review of randomised trials.
Ketamine, an N-methyl-D-aspartate receptor antagonist, is known to be analgesic and to induce psychomimetic effects. Benefits and risks of ketamine for the control of postoperative pain are not well understood. We systematically searched for randomised comparisons of ketamine with inactive controls in surgical patients, reporting on pain outcomes, opioid sparing, and adverse effects. ⋯ The highest risk of hallucinations was in awake or sedated patients receiving ketamine without benzodiazepine; compared with controls, the odds ratio (OR) was 2.32 (95%CI, 1.09-4.92), number-needed-to-harm (NNH) 21. In patients undergoing general anaesthesia, the incidence of hallucinations was low and independent of benzodiazepine premedication; OR 1.49 (95%CI 0.18-12.6), NNH 286. Despite many published randomised trials, the role of ketamine, as a component of perioperative analgesia, remains unclear.
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Review Comparative Study
Opioids in chronic non-cancer pain: systematic review of efficacy and safety.
Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. ⋯ The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction.