Articles: analgesics.
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Anesthesia and analgesia · Dec 2023
ReviewAntinociceptive Agents as General Anesthetic Adjuncts: Supra-additive and Infra-additive Interactions.
The hypothesis "General anesthesia consists of producing both loss of consciousness and the inhibition of noxious stimuli reaching the brain and causing arousal" was used as a basis for the review of published data on general anesthetic interactions with antinociceptive agents: opioids, α 2 adrenergic agonists, and systemic sodium channel blockers. This review is focused on a specific type of anesthetic interaction-the transformation of antinociceptive agents into general anesthetic adjuncts. The primary aim is to answer 2 questions. ⋯ The following terms related to drug interactions were used: anesthetic interactions, synergy, antagonism, isobolographic analysis, response surface analysis, and fractional analysis. The interactions of antinociceptive agents with general anesthetics result in a decrease of general anesthetic requirements, which differ for each of the components of general anesthesia: hypnosis, immobility, and hemodynamic response to noxious stimulation. Most studies of the nature of anesthetic interactions are related to opioid-general anesthetic combinations, and their conclusions usually confirm supra-additivity.
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Minerva anestesiologica · Dec 2023
The postoperative analgesia of retrolaminar block in patients undergoing surgery with general anesthesia: a systematic review.
Postoperative pain has always been a difficult problem in anesthesia management. The neurological block technique has been used for postoperative analgesia management, but compared with the traditional block method, the effect of postoperative analgesia after layer block is still controversial, and a clear literature review is needed. This systematic review's goal was to investigate RLB's impact on postoperative analgesia. ⋯ Based on the results of this review, RLB can be applied to thoracic surgery, abdominal surgery and parotid surgery, but its analgesic effect is not significant enough, and further research is needed in the future to provide stronger evidence for postoperative analgesia in surgical patients.
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Reg Anesth Pain Med · Dec 2023
Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations.
This study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services. ⋯ The SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids.
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To assess whether the risk of persistent opioid use after surgery varies by payer type. ⋯ Persistent opioid use remains common among individuals undergoing surgery and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.
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Journal of anesthesia · Dec 2023
Randomized Controlled TrialThe efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial.
In the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery. ⋯ Compared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores.