Articles: analgesics.
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Randomized Controlled Trial
Low-Impact Laparoscopy vs Conventional Laparoscopy for Appendectomy: A Prospective Randomized Trial.
Low-impact laparoscopy (LIL), combining low-pressure insufflation and microlaparoscopy, is a surgical technique that is still not widely used and that has never been evaluated for the management of acute appendicitis. The aim of this study is to assess the feasibility of an LIL protocol, to compare postoperative pain, average length of stay, and in-hospital use of analgesics by patients who underwent appendectomy according to a conventional laparoscopy or an LIL protocol. ⋯ In uncomplicated acute appendicitis, the LIL protocol could reduce postoperative pain and average length of stay compared to conventional laparoscopic appendectomy.
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Curr Opin Anaesthesiol · Oct 2023
ReviewChronic post amputation pain: pathophysiology and prevention options for a heterogenous phenomenon.
Chronic postamputation pain (cPAP) remains a clinical challenge, and current understanding places a high emphasis on prevention strategies. Unfortunately, there is still no evidence-based regimen to reliably prevent chronic pain after amputation. ⋯ Phantom limb pain is a multifactorial process involving profound functional and structural changes in the peripheral and central nervous system. These changes interact with individual medical, psychosocial and genetic patient risk factors. The patient collective of amputees is very heterogeneous. Available evidence suggests that efforts should focus on prevention of phantom limb pain, since treatment is notoriously difficult. Questions as yet unanswered include the evidence-base of specific analgesic interventions, their optimal "window of opportunity" where they may be most effective, and whether patient stratification according to biopsychosocial risk factors can help guide preventive therapy.
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Review
Improving Perioperative Pain Education for Patients Prescribed Opioids: An Integrative Review.
Postoperative pain is still inadequately managed for a significant number of patients despite the extensive use of opioids. Among several pain management strategies, patient education is a vital component of perioperative pain management. However, perioperative education practices remain inconsistent and incomplete in many hospital settings. ⋯ The findings from this review will help nursing professionals across surgical specialties identify effective educational approaches for patients prescribed opioids during the perioperative period. Developing education interventions based on these findings would enhance the quality and effectiveness of pain education, improve patient understanding and their preparedness to manage pain at home, and, ultimately, promote the safe use of opioids postoperatively.
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Thyroid and parathyroid operations are among the most commonly performed surgeries in the world; however, there remains a paucity of prospective clinical trials evaluating the efficacy of opioid-sparing protocols after surgery. ⋯ An opioid-sparing treatment algorithm based on the use of acetaminophen/ibuprofen may offer a safe and effective treatment algorithm compared to a primary opioid-focused treatment pathway. Randomized adequately powered studies are needed to confirm these findings.
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The quality of postoperative pain management is often poor. A "bundle," a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a "Perioperative Pain Management Bundle" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs). ⋯ We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect.