Articles: analgesics.
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Randomized Controlled Trial Multicenter Study
Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial.
What did they do?
Kowark and friends randomised 343 patients across four German hospitals to receive desflurane, sevoflurane or propofol for maintenance anesthesia using a laryngeal airway for surgery expected to be up to 2 hours.
And they found?
There was no difference in airway reactions among the three groups, and the desflurane patients emerged (statistically) significantly faster.
Hang on...
But the difference in emergence times was, i) at most only 2 minutes, and ii) was a surrogate marker for what actually matters – when a patient leaves the PACU or hospital – which wasn't reported.
Additionally, the study protocol very prescriptively defined when volatiles were decreased (50% at 5 min before expected surgical finish) and ceased – the same for both Des and Sevo. Yet it is common practice to begin weaning Sevo earlier than Des if trying to achieve comparable emergence.
Could this even be applied to my patients?
Probably not. Unless you are in the habit of using remifentanil infusions (0.15 mcg/kg/min) for surgery that almost certainly does not justify its use and have access to uniquely European analgesics piritramide and metamizole.
The elephant in the room...
Why do we persist in trying to find new justifications for desflurane, given its expense and high environmental costs? (And for that matter, remifentanil?!).
This study demonstrates the well known faster pharmacokinetics of desflurane during an unnecessarily complex laryngeal mask anesthetic, and yet adds little to meaningful clinical outcomes.
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Randomized Controlled Trial Multicenter Study
Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery: A prospective, randomized, double-blinded, multiple-center clinical trial.
A randomized controlled trial was performed to compare analgesic effects and adverse effects of oxycodone and sufentanil in patient-controlled intravenous analgesia (PCIA) after abdominal surgery under general anesthesia. ⋯ Compared with sufentanil PCIA, oxycodone PCIA showed better analgesic effects, lower incidence of adverse complications, and less analgesic drug consumption during postoperative pain management.
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Randomized Controlled Trial Multicenter Study
Medial Open Transversus Abdominis Plane (MOTAP) Catheters Reduce Opioid Requirements and Improve Pain Control Following Open Liver Resection: A Multicenter, Blinded, Randomized Controlled Trial.
Conventional management of pain following open liver resection involves intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. The objective of this trial was to assess the efficacy of a regional technique called Medial Open Transversus Abdominis Plane (MOTAP) catheter analgesia compared with IV PCA. ⋯ MOTAP catheter analgesia reduces opioid requirements, pain, and length of hospital stay compared with IV PCA following open liver resection with subcostal incisions.
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Randomized Controlled Trial Multicenter Study
Phenotypic and treatment outcome data on SUNCT and SUNA, including a randomised placebo-controlled trial.
Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs). Methods Here, 65 SUNCT (37 males) and 37 SUNA (18 males) patients were studied to describe their clinical manifestations and responses to treatment. Results Pain was almost always unilateral and side-locked. ⋯ For short-term prevention, both syndromes were highly responsive to intravenous lidocaine by infusion; for long-term prevention, lamotrigine and topiramate were effective for SUNCT, and lamotrigine and gabapentin were efficacious in preventing SUNA attacks. A randomized placebo-controlled cross-over trial of topiramate in SUNCT using an N-of-1 design demonstrated it to be an effective treatment in line with clinical experience. Conclusions SUNCT and SUNA are rare primary headache disorders that are distinct and very often tractable to medical therapy.