Articles: analgesics.
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Meta Analysis Comparative Study
Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis.
Harms and benefits of opioids for chronic noncancer pain remain unclear. ⋯ In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.
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Meta Analysis
Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses.
This systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD). ⋯ Patients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.
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Cochrane Db Syst Rev · Dec 2018
Meta AnalysisPre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery.
Postoperative pain is a common consequence of surgery and can have deleterious effects. It has been suggested that the administration of opioid analgesia before a painful stimulus may improve pain control. This can be done in two ways. We defined 'preventive opioids' as opioids administered before incision and continued postoperatively, and 'pre-emptive opioids' as opioids given before incision but not continued postoperatively. Both pre-emptive and preventive analgesia involve the initiation of an analgesic agent prior to surgical incision with the aim of reducing intraoperative nociception and therefore postoperative pain. ⋯ Due to the low quality of the evidence, we are uncertain whether pre-emptive opioids reduce postoperative pain. Based on the trials conducted thus far, there was no clear evidence that preventive opioids result in reductions in pain scores. It was unclear if there was a reduction in morphine consumption due to very low-quality of evidence. Too few studies reported adverse events to be able to draw any definitive conclusions. Once assessed, the two studies awaiting classification may alter the conclusions of the review.
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Fascia iliaca compartment block (FICB) provides an analgesic option for positioning before spinal anesthesia in patients suffering from a femur fracture. The evidence supporting FICB is still not well established. The aim of our study is to assess the efficacy and safety of FICB comparing with intravenous analgesic (IVA) on the quality for positioning before spinal anesthesia in participants with a femur fracture. ⋯ Three studies comprising 141 participants showed that FICB compared to IVA led to a significant between-group standard mean differences in quality during positioning within 30 minutes before spinal anesthesia (standardized mean difference (SMD) -2.02, 95% confidence interval (CI): -2.43 to -1.61, I = 0%) and time for spinal anesthesia (pooled mean difference (PMD) -2.86 minutes, 95% CI -3.70 to -2.01, I = 0%). Two studies with 101 participants suggested that FICB is superior to IVA on opioid requirements 24 hours postoperatively (pooled odds ratio (POR): 0.11, 95% CI: 0.03 to 0.35, I = 13%). There were no significant differences in complications or hemodynamic effects CONCLUSIONS:: Comparing with IVA, FICB can provide significantly better quality during positioning of femur fracture patients for a spinal block and a shorter time for spinal anesthesia. FICB is safe method.
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J Pain Palliat Care Pharmacother · Dec 2018
Meta AnalysisA Systematic Review of the Evidence Behind Use of Reduced Doses of Acetaminophen in Chronic Liver Disease.
Acetaminophen is among the most commonly used nonopioid analgesics, but significant variation exists in its prescribing practices for cirrhosis patients. Our primary objective was to describe the quality of evidence supporting or refuting the use of acetaminophen in patients with hepatic dysfunction. A comprehensive literature review of PubMed, Cochrane Library, Web of Science, and International Pharmaceutical Abstracts using the search terms "acetaminophen," "paracetamol," "chronic liver disease," "cirrhosis," and "hepatic disease" for studies describing changes in acetaminophen metabolism in patients with hepatic dysfunction was conducted. ⋯ The level of certainty for dosing recommendations obtainable from reviewing the evidence is low due to a small number of studies meeting search criteria, small samples sizes, inadequate information regarding cirrhosis etiology and compensated versus uncompensated liver disease, and lack of information on patient centered health outcomes. High-quality trials are not available to support the use of decreased acetaminophen doses in compensated cirrhosis patients. Acetaminophen can be a safe analgesic in patients with compensated hepatic dysfunction after careful analysis of patient-specific factors.