Articles: opioid-analgesics.
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Arch Orthop Trauma Surg · Jan 2021
Union rate, complication rate, and opioid usage after Vancouver B periprosthetic femur fractures: a comparison of fracture types.
Periprosthetic femur fractures are complex injuries that can be difficult to treat and recover from. With a growing number of total hip arthroplasties (THA) and revision arthroplasties being performed in an aging population, the incidence of these injuries is on the rise. Multiple studies exist detailing outcomes associated with periprosthetic femur fractures after THA, but no study has directly compared the post-operative course between fracture types as classified by the Vancouver classification system. This study compares the three Vancouver B fracture types to see if any type is associated with an increase in post-operative complications than others. ⋯ Prognostic level III.
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Review Meta Analysis
Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis.
This study is a systematic review of interventions to improve adherence to guideline recommendations for prescribing opioids for chronic noncancer pain. ⋯ Mostly very low-certainty evidence supports a number of interventions for improving adherence to risk management strategies when prescribing opioids for chronic noncancer pain; however, the effect on patient important outcomes (e.g., overdose, addiction, death) is uncertain.
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Chronic low back pain (CLBP) incurs huge costs owing to increased healthcare expenditure, disability, insurance, and work absenteeism. Opioid analgesics are commonly used for the management of CLBP. ⋯ Oxymorphone has an advantage over other opioids to reduce pain by 30% and 50% in patients with CLBP.
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J Pain Symptom Manage · Jan 2021
Meta AnalysisEfficacy and safety of opioids in treating cancer-related dyspnea: A systematic review and meta-analysis based on randomized controlled trials.
Dyspnea is one of the most distressing symptoms encountered by advanced cancer patients. In this study, we aimed to evaluate the role of opioids in the management of cancer-related dyspnea. ⋯ Our systematic review and meta-analysis indicated low quality evidence for a small positive effect of opioids in cancer-related dyspnea. Evidence for safety is insufficient as comprehensive adverse events were not adequately reported in studies.
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Anesthesia and analgesia · Jan 2021
Observational StudyFinancial and Clinical Ramifications of Introducing a Novel Pediatric Enhanced Recovery After Surgery Pathway for Pediatric Complex Hip Reconstructive Surgery.
Enhanced recovery after surgery pathways confer significant perioperative benefits to patients and are currently well described for adult patients undergoing a variety of surgical procedures. Robust data to support enhanced recovery pathway use in children are relatively lacking in the medical literature, though clinical benefits are reported in targeted pediatric surgical populations. Surgery for complex hip pathology in the adolescent patient is painful, often requiring prolonged courses of opioid analgesia. Postoperative opioid-related side effects may lead to prolonged recovery periods and suboptimal postoperative physical function. Excessive opioid use in the perioperative period is also a major risk factor for the development of opioid misuse in adolescents. Perioperative opioid reduction strategies in this vulnerable population will help to mitigate this risk. ⋯ The impacts of our pediatric enhanced recovery pathway for adolescents undergoing complex hip reconstruction are consistent with the ongoing improvement in perioperative metrics at our institution but are difficult to distinguish from the impacts of other initiatives and evolving practice patterns in a pragmatic setting. The ERAS pathway helped codify and organize this new pattern of care, promoting multidisciplinary evidence-based care patterns and sustaining positive preexisting trends in financial and clinical metrics.