Pain management
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Review
Obstructive sleep apnea in adult patients: considerations for anesthesia and acute pain management.
Obstructive sleep apnea (OSA) represents a challenge in the perioperative period for both physicians and the health care system alike. A number of studies have associated OSA with increased risk for postoperative complications. ⋯ Other interventions such as the use neuraxial/regional anesthesia may however offer added benefit. This review aims to address considerations for physicians in charge of OSA patients in the perioperative setting and to give an outlook for current and future research on this topic.
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Chronic postsurgical pain is a significant complication following major surgery, which impairs patient's quality of life. Opioid medications are the mainstay of most postoperative analgesic regimens. ⋯ There is a paucity of literature regarding the safe and effective management of postoperative pain as patients transition from the hospital to home/community. The introduction of a transitional pain service, whose aim is to optimize pain control, monitor and appropriately wean patients off opioid medications, prevent unnecessary readmissions post-discharge, and reduce disability associated with the development of chronic post surgical pain, will be of benefit to patients and the healthcare system.
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All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. ⋯ Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor.
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Epidural steroid injections (ESIs), which can provide significant but temporary pain relief in well-selected patients, are the most commonly performed procedure in pain management. The anatomy of the epidural space provides a framework for understanding risks associated with ESIs, a topic relevant to both patients and physicians in interventional pain, surgery and primary care. ⋯ Although major complications associated with ESI occur rarely, potentially catastrophic events resulting from infectious, hematologic and neurologic morbidity may lead to permanent injury. The safety profile of ESIs may improve with development and dissemination of sound injection technique, safer compounds manufactured in a sterile manner and deficient of thromboembolic potential and the application of existing technology.
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The sufentanil sublingual tablet system (SSTS) is a novel patient-controlled analgesia (PCA) system that is pending approval from the US FDA for the management of moderate to severe acute pain in hospitalized patients. SSTS offers a noninvasive alternative to intravenous (iv.) PCA and optimized on-demand analgesia with the rapid onset and titratibility of sublingual sufentanil. Phase III clinical trials have demonstrated that SSTS has greater efficacy for the treatment of pain during the 72-h postoperative period after open abdominal and major orthopedic (total knee or total hip arthroplasty) surgery compared with iv. ⋯ Safety assessments indicate that adverse events are typical for postoperative patients taking opioid analgesics. While the frequency of adverse events is comparable between patients using SSTS and iv. PCA MS, the incidence of oxygen desaturation is lower in those using SSTS.