Articles: pain-management-methods.
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Randomized Controlled Trial Comparative Study
Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial.
Breast cancer is the most common malignancy of women all over the world. In this study, we compared the effects of ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane (ESP) block on postoperative opioid consumption, pain scores, and intraoperative fentanyl need of patients undergoing unilateral modified radical mastectomy surgery. ⋯ Modified PECS block reduced postoperative tramadol consumption and pain scores more effectively than ESP block after radical mastectomy surgery.
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The Journal of urology · May 2019
Comparative StudyOpioid Prescription and Use in Sacral Neuromodulation, Mid Urethral Sling and Pelvic Organ Prolapse Surgery: An Educational Intervention to Avoid Over Prescribing.
The opioid problem has reached epidemic proportions and the prescription of opioids after surgery can lead to chronic use. We explored prescribing patterns and opioid use after 3 pelvic floor surgeries (sacral neuromodulation, prolapse repair and mid urethral sling) before and after an educational intervention to reduce opioid prescriptions. ⋯ Our data demonstrate that over prescription of opioids after pelvic floor surgery and a provider educational intervention resulted in a significant reduction in opioid prescribing without changing patient satisfaction with pain control.
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Randomized Controlled Trial
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention.
Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain. ⋯ Dexmedetomidine, paravertebral block, video-assisted thoracoscopic surgery, postoperative pain, chronic pain.
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Observational Study
Safety, complications and clinical outcome after ultrasound-guided paravertebral catheter insertion for rib fracture analgesia: a single-centre retrospective observational study.
Rib fractures are associated with significant morbidity and mortality. Ultrasound-guided thoracic paravertebral catheter insertion has been described for the management of pain secondary to rib fractures. We conducted a retrospective observational study of all patients with rib fractures who had a paravertebral catheter inserted for analgesia provision over a 4-year period. ⋯ The proportion of rib fracture patients managed with paravertebral catheters increased from 31/200 (15.5%) in the first year of study to 81/168 (48.2%) in the fourth; over this time-period the observed:predicted mortality ratio fell from 1.04 to 0.66. Proportional hazard regression with and without propensity score matching demonstrated a reduction in mortality associated with paravertebral catheter use, but this became statistically non-significant when time-dependent analysis was used. Paravertebral catheters are a safe and effective technique for rib fracture analgesia; however, our data were insufficient to demonstrate any improvement in mortality.
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Multicenter Study
High on drugs: Multi-institutional pilot study examining the effects of substance use on acute pain management.
Substance use and abuse may have the significant, but unanticipated, consequence of lessening the efficacy of opioid analgesics for acute pain management. We hypothesized that pre-injury substance use increases opioid analgesic consumption following traumatic injury. ⋯ Our preliminary data suggest drug use may significantly alter acute pain management following traumatic injury, corresponding to 40% increase in opioid analgesia for substance users than non-users. These results may have broad reaching implications because of the high prevalence of substance use in the trauma population.