Articles: analgesics.
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Multicenter Study
Effectiveness of a Rural Emergency Department (ED)-Based Pain Contract on ED Visits Among ED Frequent Users.
Caring for patients with chronic pain in emergency departments (EDs) can be particularly challenging, for both patients and physicians. ⋯ A pain contract protocol was associated with a significant reduction in the number of ED visits to multiple rural EDs.
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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
Decreased opioid consumption and enhance recovery with the addition of IV Acetaminophen in colorectal patients: a prospective, multi-institutional, randomized, double-blinded, placebo-controlled study (DOCIVA study).
We hypothesized that administration of IV acetaminophen alone would reduce the opioid consumption in post-operative colorectal surgery and reduce the side effects of narcotics. ⋯ IV acetaminophen helps to reduce opioid consumption for patients undergoing colorectal surgery. Additionally, there appears to be a shortened length of hospital stay, better pain control, reduced time to return of bowel function, and lower rate of post-operative ileus in patients receiving IV acetaminophen.
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Multicenter Study
Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System.
Opioids are commonly used for pain control during and after invasive procedures. However, opioid-related adverse drug events (ORADEs) are common and have been associated with worse patient outcomes. ⋯ Opioid-related adverse drug events were common among patients undergoing hospital-based invasive procedures and were associated with significantly worse clinical and cost outcomes. Hospital-acquired harm from ORADEs in the surgical patient population is an important opportunity for health systems to improve patient safety and reduce cost.
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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.