Articles: analgesics.
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Reg Anesth Pain Med · Feb 2025
ReviewMachine learning research methods to predict postoperative pain and opioid use: a narrative review.
The use of machine learning to predict postoperative pain and opioid use has likely been catalyzed by the availability of complex patient-level data, computational and statistical advancements, the prevalence and impact of chronic postsurgical pain, and the persistence of the opioid crisis. The objectives of this narrative review were to identify and characterize methodological aspects of studies that have developed and/or tested machine learning algorithms to predict acute, subacute, or chronic pain or opioid use after any surgery and to propose considerations for future machine learning studies. Pairs of independent reviewers screened titles and abstracts of 280 PubMed-indexed articles and ultimately extracted data from 61 studies that met entry criteria. ⋯ We identified variability in sample size, number and type of predictors, and how outcome variables were defined. Patient-reported predictors were highlighted as particularly informative and important to include in such machine learning algorithms, where possible. We hope that findings from this review might inform future applications of machine learning that improve the performance and clinical utility of resultant machine learning algorithms.
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Randomized Controlled Trial
Safety and efficacy of low-dose esketamine weakly opioidized anesthesia in elderly patients with lumbar spinal stenosis undergoing surgery: a prospective, double-blind randomized controlled trial.
The perioperative use of esketamine may reduce opioid use and their adverse effects. We aimed to evaluate the intraoperative safety and efficacy of weak opioidized anesthesia with low-dose esketamine in the treatment of elderly patients with lumbar spinal stenosis undergoing total laminectomy with complete decompression and interbody implant fusion. ⋯ Low-dose esketamine is used for its anti-inflammatory and analgesic effects in lumbar spine surgery of elderly patients. It is beneficial to hemodynamic stabilization and can reduce the incidence of postoperative respiratory depression in elderly patients. Among them, 0.2 mg/kg induction and 0.25 mg/(kg-h) infusion were more effective.
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Randomized Controlled Trial Comparative Study
A randomized controlled trial to compare the effect of oxycodone and sufentanil on postoperative analgesia and immune function for laparoscopic resection of colorectal cancer.
The purpose of this study is to evaluate the effect of oxycodone and sufentanil on postoperative analgesia and immune function in patients with laparoscopic resection of colorectal cancer (CRC), as well as the serum level of inflammatory cytokine. ⋯ Oxycodone is more effective than sufentanil in alleviating visceral pain, although it does not surpass sufentanil in managing cutting pain. In addition, there is no significant superiority in the effects of oxycodone on immune function and inflammatory cytokine release compared to sufentanil.
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Minerva anestesiologica · Feb 2025
Modified thoracoabdominal nerves block through perichondrial approach is effective in reducing postoperative opioids requirements in patients undergoing laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis.
The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC. ⋯ M-TAPA block provides superior analgesia when compared with control group in LC.
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Scand J Trauma Resus · Feb 2025
The use of strong analgesics for prehospital pain management in children in the region of Southern Denmark: a register-based study.
Acute pain in the prehospital setting is frequent and prehospital pain management presents multiple challenges, especially in children. There is a lack of high-level evidence regarding prehospital pain management in the paediatric population worldwide. In Denmark, this lack of evidence particularly concerns the frequency of the prehospital use of strong analgesics. Guidelines are sparse but there is evidence that prehospital fentanyl may be administered up to 5 µg/kg. ⋯ The doses of opioids as administered by the EMS personnel seem safe as 97% of the doses were within the recommended range and even at the lower end of the recommended range. Although apparently safe, the utilisation of strong analgesics points to a risk of under-treating pain in children.