Pain management
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An online database search with subsequent article review was performed in order to review the various analgesic modalities for breast cancer surgery. Of 514 abstracts, 284 full-length manuscripts were reviewed. The effect of pharmacologic interventions is varied (NSAIDS, opioids, anticonvulsants, ketamine, lidocaine). ⋯ Conversely, abundant evidence demonstrates paravertebral blocks and thoracic epidural infusions provide effective analgesia and minimize opioid requirements, while decreasing opioid-related side effects in the immediate postoperative period. Other techniques with promising - but extremely limited - data include cervical epidural infusion, brachial plexus, interfascial plane and interpleural blocks. In conclusion, procedural interventions involving regional blocks are more conclusively effective than pharmacologic modalities in providing analgesia to patients following surgery for breast cancer.
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This article reviews the complexities of the opioid epidemic, considering recent research involving the current state of the opioid epidemic; chronic pain and its role in the crisis; the properties of opioids and how they interact with human neurobiology; the effectiveness and risks of opioids as a treatment for chronic pain; opioid addiction and dependence; and pharmacological and psychological interventions for opioid addiction, opioid dependence, and chronic pain management. Opioid abuse can be reduced with the availability and access to treatment facilities for opioid detoxification; using interdisciplinary treatment models for chronic pain, opioid addiction and dependence; conducting more research in the areas of opioid addiction and opioid dependence; and shifting to an increase in nonpharmacological, less invasive treatments for pain.
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To compare outcomes of continuous subcutaneous infusion of local anesthetic and epidural analgesia following the Nuss procedure. ⋯ Continuous subcutaneous infusion of local anesthetic could eliminate the need for thoracic epidural for pain management after the Nuss procedure.
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Randomized Controlled Trial Comparative Study
The comparative pharmacokinetics of physical manipulation by crushing of Xtampza® ER compared with OxyContin®.
To further characterize the pharmacokinetics of Xtampza® ER. ⋯ This second pharmacokinetic study demonstrated that Xtampza ER maintains its ER properties after crushing, unlike OxyContin, which failed to retain its ER properties after crushing. ANZCTR registration number: ACTRN12614000613606.
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The goal of our review was to emphasize important aspects that physicians should take into consideration when prescribing topical analgesics as part of chronic neuropathic pain treatment. We discuss the dermatopharmacokinetics and microstructural components of the skin, differences between topical and transdermal drug delivery, and topical medication effects on peripheral neuropathy and central sensitization. ⋯ Furthermore, we discuss new compounded topical analgesics that are becoming more popular and that are showing promising results in the management of chronic peripheral neuropathies. However, more studies are needed for elucidation of the role of topical analgesics and their effects, especially when combined with other treatments.