Current opinion in anaesthesiology
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This review highlights new insights into the mechanism of action of paracetamol (acetaminophen) and therapeutic schemes. ⋯ Further studies are required to assess the opioid-sparing effect and complementary analgesic effect of new intravenous paracetamol therapeutic schemes.
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Much effort has been taken to prove that a treatment initiated before surgery is more effective in reducing postoperative pain compared with the same intervention started after surgery. Clinical studies failed to demonstrate major clinical benefits of preemptive analgesia, however, and the results of recent systemic reviews are equivocal. The present review will discuss recent clinical as well as experimental evidence of preemptive analgesia and examine the implications of a preventive postoperative pain treatment. ⋯ Extending a multimodal analgesic treatment into the postoperative period to prevent postoperative pain may be superior compared with preemptive analgesia. In the future, appropriate drug combinations, drug concentrations and duration of preventive strategies need to be determined to be most beneficial for the management of acute and chronic pain after surgery.
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The review presents an overview of indications, limitations and practical aspects of regional anesthesia and analgesia in critically ill medical and surgical patients. ⋯ Regional anesthesia and analgesia in the critically ill can help to improve respiratory function, bowel function, mental status and patient comfort secondary to its opioid-sparing effects. Limitations for the use of regional anesthetic techniques are mainly associated with bleeding risks, hemodynamic side-effects, difficulties in neurologic assessment and the potential of local anesthetic toxicity.
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Incisional pain remains underevaluated and undermanaged while evidence is growing that perioperative treatments strongly influence patients' outcome. The present review examines the recent developments in mechanisms underlying perioperative pain and questions current understanding of incisional pain features observed in patients. ⋯ Experimental studies and recent clinical trials using objective measures of sensory processing sensitization induced by surgical incision have shown the importance of hyperalgesia in perioperative pain. Effective perioperative block of nociceptive inputs from the wound as well as use of antihyperalgesic and analgesic drugs in combination seem the best way to control postoperative pain and specifically to prevent central sensitization.
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Curr Opin Anaesthesiol · Oct 2006
ReviewAntidepressants as local anesthetics: is there a place in regional anesthesia?
Antidepressants have multiple sites of action. Among these, the ability to inhibit sodium channels has led to the increased interest in their use as local anesthetics. The following review summarizes the results of recent studies on this topic. ⋯ Although antidepressants indeed act as potent local anesthetics, their use in the clinical setting cannot be recommended as of today due to extensive local tissue toxicity.