British journal of anaesthesia
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Multi-injection targeted intracluster injection ultrasound-guided supraclavicular brachial plexus block has been advocated to provide a faster onset of anaesthesia compared with a double injection technique. By placing the needle within clusters of hypoechoic structures, corresponding to neural tissue, this technique may increase needle trauma and the incidence of nerve injury. This study assessed the rate of sub-perineural needle placement with a single intracluster brachial plexus injection in the supraclavicular fossa of human cadavers. ⋯ We observed a high rate of sub-perineural injection with a single intracluster injection. Thus the targeted intracluster injection supraclavicular block cannot be recommended until further evidence is available regarding the safety of this technique.
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Randomized Controlled Trial Multicenter Study
Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study.
Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. ⋯ EudraCT: 2012-004219-30; NCT01882530.
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Review Meta Analysis
Evidence of opioid-induced hyperalgesia in clinical populations after chronic opioid exposure: a systematic review and meta-analysis.
Opioid-induced hyperalgesia (OIH) is well documented in preclinical studies, but findings of clinical studies are less consistent. The objective was to undertake a systematic review and meta-analysis of studies examining evidence for OIH in humans after opioid exposure. ⋯ OIH was evident in patients after chronic opioid exposure, but findings were dependent upon pain modality and assessment measures. Further studies should consider evaluating both pain threshold and pain tolerance across a range of modalities to ensure assessment validity. Significant subgroup findings suggest that potential confounders of pain judgements, such as illicit substance use, affective characteristics, or coping styles, should be rigorously controlled in future studies.