Articles: pain-management-methods.
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Curr Pain Headache Rep · May 2017
ReviewAnesthetic and Analgesic Management for Outpatient Knee Arthroplasty.
Total knee arthroplasty traditionally has been associated with significant postoperative pain that can limit recovery and prolong hospital length of stay. Recently, however, due to financial pressures and an emphasis on improving patient satisfaction, many institutions are implementing outpatient and short-stay programs for patients undergoing this procedure. An effective perioperative anesthetic plan is an essential quality of a successful outpatient joint replacement program. ⋯ Improved technology and innovation has led to more effective and efficient strategies that contribute to a smoother and quicker postoperative course. The use of peripheral nerve blocks in conjunction with a variety of systemic analgesics has reduced post-operative pain compared to older modalities. Specifically, the adductor canal and IPACK blocks have become increasingly popular due to their analgesic efficacy and muscle sparing characteristics. Outpatient knee arthroplasty is becoming a reality with advancements in surgical pathways that incorporate these newer modalities with an emphasis on multidisciplinary coordination.
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The term complex regional pain syndrome (CRPS) describes a variety of painful conditions, which typically occur distally on an extremity following an initiating event. Characteristically CRPS exceeds the expected clinical course in both magnitude and duration. Clinical manifestations of CRPS include sensory, vasomotor, sudomotor, motor and trophic disorders. ⋯ Essential differential diagnoses in the early phase include infections, neurological compression and inflammatory conditions. Although benign courses have been reported, many patients develop a chronic condition with persisting complaints even after 1 year. Therapy is based on a variety of pharmacological, interventional, physiotherapeutic, occupational and psychiatric treatment options.
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A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative thoracic oncology. Together with the medicamentous therapy the psychologic and social circumstances of the affected patients have to be considered as factors influencing the experience of pain. The therapeutic fundament according to the WHO guideline for cancer pain is the opiate based medicamentous adjustment combined with non-opioids. ⋯ The typical adverse reaction profile for opiates like constipation and initial nausea should be considered prophylactically by applying concurrent medication with adjuvants. Co-analgesic drugs like anticonvulsiva or corticosteroids could support the analgetic effect and are used preferably in case of neuropathic pain. Primary aim in analgesic therapy is to achieve the best possible pain reduction and hence to safeguard quality of life.
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Review Meta Analysis
Comparison of intrathecal and local infiltration analgesia by morphine for pain management in total knee and hip arthroplasty: A meta-analysis of randomized controlled trial.
We performed a meta-analysis from randomized controlled trials to evaluate the efficiency and safety between local infiltration analgesia and intrathecal morphine for pain control in total knee and hip arthroplasty. ⋯ Local infiltration analgesia (LIA) provided superior analgesic effects within the first 24 h compared to intrathecal morphine (ITM) following total knee and hip arthroplasty. There were fewer adverse effects in LIA. Doses of morphine consumption were similar in the two groups.
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J Perinat Neonatal Nurs · Apr 2017
ReviewNitrous Oxide Utility in Labor and Birth: A Multipurpose Modality.
The use of nitrous oxide (N2O) for labor and birth has very recently emerged as a viable modality in the United States, despite a long history of use in Canada and Europe. Usually associated with dental procedures, there are significant differences between dental and parturition utility, efficacy, and staff exposure. ⋯ Nitrous oxide has proven to be especially helpful for repair of lacerations under local anesthesia and is a multiuse modality that should be available to women in all birth settings. This article explores the history of N2O use, provides a comparison of obstetrical use to use in the dental industry, examines the contraindications to, and implications for usage, and discusses logistical points of consideration for clinicians working with women using N2O for labor and birth.